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The prognostic value of blood pressure control delay in newly diagnosed hypertensive patients

Martín-Fernández, Miguela; Vinyoles, Ernesta,b; Real, Jordib,c,d; Soldevila, Núriaa,b; Muñoz, Miguel-Ángelb,c; Del-Val, José Luísb,c; Verdú, José Maríab; Domingo, Marb; Mundet, Xavierb,c,e

doi: 10.1097/HJH.0000000000001896
ORIGINAL PAPERS: Therapeutic aspects

Objective: Various studies have suggested that a delay in the time between diagnosing hypertension and its correct control (D-C, diagnostic-control time) is linked to a worse prognosis. The aim of this study was to examine the relationship between D-C time and all-cause mortality, or the incidence of cardiovascular events, in patients more than 60 years newly diagnosed with hypertension.

Methods: This is a longitudinal, retrospective, population study employing data gathered from the electronic medical records of patients recently diagnosed with hypertension in 45 primary healthcare centres located in Barcelona (Catalonia). A multivariable logistic regression and Cox regression models were constructed. Goodness-of-fit was assessed through the Hosmer & Lemeshow test.

Results: A total of 18 721 newly diagnosed hypertensive patients were included between 2007 and 2012. The follow-up lasted until October 2015, or the appearance of a cardiovascular event or death because of any cause. The median D-C time was 49 days and its distribution by tertiles was the following: 29 days or less, 30–124 days, and at least 125 days. Higher hypertensive status, obesity, diabetes mellitus, and male sex were independently associated with longer D-C time (≥125 days). At 5.4 years follow-up, patients with longer D-C times presented statistically significant greater incidence of all-cause mortality.

Conclusion: A delay in blood pressure control is significantly associated with an increase in the rate of all-cause mortality.

aLa Mina Primary Care Health Centre. University of Barcelona

bCardiovascular Research Group (GREC). Catalan Health Institute. Barcelona

cUnitat de Suport a la Recerca Barcelona. Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona

dEpidemiologia i Salut Pública, Universitat Internacional de Catalunya, Sant Cugat del Vallès

eUniversitat Autònoma de Barcelona, Barcelona, Spain

Correspondence to Ernest Vinyoles, CAP La Mina. Plaça M Àngels Rosell Simplicio, s/n. 08930 - Sant Adrià de Besòs. Barcelona, Spain. Tel: +34 933811593; fax: +34 933812141; e-mail:

Abbreviations: CI, confidence interval; D-C, diagnostic-control; IR, incidence rate; JNC, Joint National Committee; OR, odds ratio

Received 9 March, 2018

Revised 18 June, 2018

Accepted 9 July, 2018

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