Hypertension in general practice Risk factors for uncontrolled hypertension Maja Skov Paulsen Biostatistic I and Biostatistics II 2009 autumn 19.nov, 2009.

APO Audit 19. Nov, 2009Maja Skov Paulsen2 179 practice participated Nov patients included over a 3-week period. ◦ Patients with known hypertension and if the consultation included a blood pressure measurement patients completed a questionnaire

APO Audit about hypertension The phD study is based on data from: APO Audit about hypertension/Patients included APO Audit about hypertension/General Practice 179 Pratice 7111 patients diagnosed with hypertension included 5413 patient answered questionnaire 5413 patient data registered by the GPs 5878 patient data registrated by the GP 179 GP answered questionnaire about their practice Maja Skov Paulsen19. Nov, 20093

Planlagt BT- kontrol Ikke planlagt BT-kontrol Systolisk Diastolisk Familiær disposition Rygning Hyperkolesterolæmi Overvægt DMIngen af førnævnte Myokardieinfakt Anden karkomplikationIngen Non-farmakologisk behandling ACE-hæmmer Kontakt- art Aktuelle BT målt i dag Varighed af hyper- tension 1 X Mindst 1 højst 6 X Cpr nr. Praksis nr Hypertension i almen praksis 2007 Risikofaktorer for iskæmisk hjerte-karsygdom Kardio- vaskulære komplikationer Mindst 1 X 33 A II -antagonist Ca-antagonist Betablokker ®Copyright: Audit Projekt Odense, J.B. Winsløws Vej 9A, Odense C Diverse Andre antihypertensiva Individuelt behandlingsmål fastlagt Medicinændring d.d. Ingen af førnævnte Mindre end 2 år 29 Behandling Mindst 1X 2 til 5 år Mere end 5 år / / / / / / / / / / / / TCI/apoplexi Diuretika Ingen behandling For lidt motion Læge  Sygeplejerske  Sekretær/laborant/anden  1 X Ny kontrol aftaltForeligger ikke / / / / / / / / / / / / Systolisk Diastolisk Hjemme BT Tilfreds med aktuelle regulation Nov, 2009Maja Skov Paulsen4

Risk factors for the overall risk assessment: ◦ Familial history of cardiovascular disease  yes=1 no=0 ◦ Smoking  yes=1 no=0 ◦ Elevated blood level of cholesterol  yes=1 no=0 ◦ BMI  0=BMI ≤ 25  1=BMI =  2= BMI ≥ 30 ◦ Too little exercise  yes=1 no=0 ◦ Diabetes  yes=1 no=0 ◦ No risk factors  yes=1 no=0 19. Nov, 20095Maja Skov Paulsen

Cardiovascular diseases TCI/apoplexy ◦ yes=1 no=0 Myocardial infarction ◦ yes=1 no=0 Other vascular complication ◦ yes=1 no=0 No cardiovascular disease ◦ yes=1 no=0 19. Nov, 2009Maja Skov Paulsen6

Age and gender categories Age:  <40 year      ≥80 Gender:  0= Female  1=male 19. Nov, 2009Maja Skov Paulsen7

I had to recode my age-categori Table 1. Basis characteristics for 5413 patient enrolled in the study n% Gender:Female Male age 0 < , ≥ Mean age Diabetes84216 Controlled hypertension overall Uncontrolled hypertension overall Nov, 2009 Maja Skov Paulsen 8

Outcome variable Uncontrolled blodpressure  No=0 (not uncontrolled)  Yes=1 (uncontrolled) The values was coded as: ◦ 1. Home blood pressure measurement ◦ 2. Consultations blood pressure measurement 19. Nov, 2009Maja Skov Paulsen9

Outcome variable Limits ◦ Home and consultations blood pressure  Controlled: <140/90 mmHg  Uncontrolled ≥ 140/90 mmHg ◦ Diabetes patients  Controlled: < 130/80 mmHg  Uncontrolled: ≥ 130/80 mmHg 19. Nov, 2009Maja Skov Paulsen10

19. Nov, 2009 Maja Skov Paulsen11

Table 2 Crude odds. Crude odds adjusted for age, gender and cluster at practice level (179 practices) nOdds(Conf.int)p-values Familial history of cardiovascular disease Yes ( )0.119 SmokingYes ( )0.053 Elevated level of cholesterolYes ( )0.017 BMI< ( )0.342 ≥ ( )0.000 Too little exerciseYes ( )0.100 DiabetesYes ( )0.000 No risk factors ( )0.041 TCI/apoplexyYes ( )0.000 Myocardial infarctionYes ( )0.000 Other vascular diseaseYes ( )0.958 No vascular disease ( ) Nov, 2009Maja Skov Paulsen12

19. Nov, 2009Maja Skov Paulsen13

Table 3 Logistic regression model Odds ratio for uncontrolled hypertension adjusted for all including cluster at practice level (179 practices) nOdds(Conf.int)p-values Age ( ) ≥ ( )0.003 Smoking ( )0.031 Elevated level of cholesterol ( )0.002 BMI< ( )0.995 > ( )0.006 Diabetes ( )0.000 TCI/apoplexy ( )0.003 Myocardial infarction ( ) Nov, 2009Maja Skov Paulsen14

19. Nov, 2009Maja Skov Paulsen15

Antal risikofaktorer: Table 4. The total number of risk factors and the groups association to uncontrolled hypertension adjusted for age and gender. The following risk factors are included: Familial history of cardiovascular disease, smoking, cholesterol, too little exercise, diabetes and BMI (coded as BMI≤30 and BMI>30) nOdds( 95%Conf.int)p-values 0 risk factors risk factors risk factors risk factors ( ) risk factors ( ) risk factors853.01( ) risk factors143.52( ) Nov, 2009Maja Skov Paulsen16

19. Nov, 2009Maja Skov Paulsen17

Table 5 Testparm The following interactions were included in the logistic model to investigate if they should be included in the model. Interactionchi2(1)Prob> chi2 Included (Yes/No) SmokingCholesterol No Familial history of cardiovascular disease No Myocardial infarction No TCI/apoplexy No CholesterolDiabetes No MI OBS TCI/apoplexy No BMIDiabetes OBS Cholesterol No MI No 19. Nov, 2009Maja Skov Paulsen18

Interactioner BMI og diabetes:  Odds ratio 1.48 ( ) p=0.055 Cholesterol og AMI:  Odds ratio 1.51 ( ) p= Nov, 2009Maja Skov Paulsen19