Based on SEPHAR II survey data, high level of education and income, together with low BP variability, decreased arterial stiffness and treatment with at least 3 antihypertensive drugs (including a diuretic) can predict the therapeutic control of blood pressure with an accuracy of 76%. The aim of this study is to verify the validity of this model on the data form SEPHAR III survey and to find out if other factors can contribute to its improvement.
Design and method:
A total of 889 hypertensive adult subjects identified in SEPHAR III survey (mean age 55.79 ± 15.68 years, 49% females) were evaluated by 3 sitting BP measurements per study visit,weist, hight and weight measurements, pulse wave velocity in the aorta (PWVao), transthoracicechocardiography, 12-lead ECG, noninvasive hemodinamic evaluation,serum lipid profile, fasting plasma glucose and glycated hemoglobine, urinary albumin excretion and estimation of Na urinary excretion in morning urinary spot sample. BP control was defined as less than 140mmHg over 90mmHg at both study visits.Increased BP variability was defined as visit-to-visit standard deviation (s.d.) of SBP values above 8.49 mmHg.
the majority of the hypertensives were treated - 72.2%, optimal BP control was recorded in only 22.3%.
Binary logistic regression analysis validated as predictors of optimal BP control the following: PWVao (OR = 1.552), SD_SBP values below 8.49 mmHg (OR = 3.01), low CV risk abdominal adiposity category (OR = 2.37), the absence of hypervolemia (OR = 3.35), low levels of Na urinary excretion (OR = 1.03) and the treatment with 3 antihypertensive drugs including an diuretic (OR = 1.97).The new model has a power of 85.2% of correctly predicting BP control.
results reconfirms arterial stiffness and SBP variability as major determinants of BP control, highlighting the need of treatment strategies that positively impacts them. More, the confirmation the link between hypervolemic state, level of sodium urinary excretion, intensive antihypertensive treatment that include an diuretic and BP control, indicates that the major cause of low BP control in our adult population is due to an increased sodium intake, requiring immediate actions for limiting dietary sodium intake.