Prevalence, awareness, and control of arterial hypertension in Denmark

doi:10.1016/j.jash.2008.08.001

Journal of the American Society of Hypertension

Volume 3, Issue 1, January–February 2009, Pages 19-24.e2

https://doi.org/10.1016/j.jash.2008.08.001 Get rights and content

Abstract

Hypertension is an important modifiable risk factor for cardiovascular disease. Risk is reduced by reduction of blood pressure (BP). The present survey estimated the prevalence of hypertension, awareness, treatment, and BP control in Denmark. BP was measured three times on one occasion in a representative sample (n = 7,767) of the Danish population ages 20 to 89 years. Persons with screening BP ≥140/90 mm Hg also measured BP at home. Participants with home BP ≥135/85 mm Hg in general and ≥125/75 mm Hg for patients with diabetes or renal disease were categorized as hypertensive together with those already on antihypertensive treatment. Awareness was registered by questionnaire. Treated patients with BP below relevant limits were categorized as controlled. Age-adjusted prevalence of hypertension was on the basis of screening BP 25.7% and by home BP 22.3%. Seventy-two percent of patients found hypertensive by home BP were aware of it, 64% were treated, and 57% of those treated were controlled by office BP and 68% by home BP. One-fifth of the adult Danish population was found to be hypertensive, Awareness and control of hypertension was better than in most previous reports. Control rates similar to those of clinical trials are achievable in clinical practice.

Introduction

High blood pressure (BP) is an important risk to health in all parts of the world. It increases the risk of cardiovascular disease; thus, about two-thirds of cerebrovascular disease and half of ischemic heart disease is attributable to arterial hypertension.1, 2 There is ample evidence that the cardiovascular risk in hypertensive patients is reduced significantly by lowering BP, most effectively with the aid of antihypertensive drugs.³

Normalization of BP is not easily achieved, even in controlled trials with optimal motivation both for patients and for treating physicians. The recommended goal of a diastolic BP lower than 90 mm Hg is frequently achieved, whereas a systolic BP lower than 140 mm Hg presents a greater problem. The lower goals for hypertensive patients with diabetes and nephropathy are infrequently reached.⁴ Surveys of antihypertensive treatment in clinical practice have shown even less favorable results.⁵

A recent analysis estimated that more than one-fourth of the world's adult population is hypertensive, with considerable variation in prevalence between regions.⁶ In economically developed countries, only half to two-thirds of the hypertensive population were aware of the diagnosis, fewer than half of them were treated, and less than one-third of hypertensives had their BP controlled by treatment. In economically developing counties, the results are even more dismal.⁵

The task of today's health services is to transfer available knowledge of effective antihypertensive treatment from controlled trials to clinical practice. The present survey is a study of the prevalence, awareness, treatment, and control of hypertension in Denmark.

Section snippets

Methods

The study was designed as a representative cross-sectional survey of the Danish population. For practical reasons, it was based on a population sample randomly drawn from a geographic area comprising the city of Odense (the home of The University of Southern Denmark) and three surrounding rural municipalities. The necessary sample size was calculated on the basis of expected prevalence based on data from the National Health and Nutrition Examination Survey III and Inter-99 surveys,7, 8 and

Results

The comparison of socioeconomic status and health-related characteristics of the source population with the Danish population as a whole showed only minor differences (see Supplemental Table 1, Supplemental Table 2 available at Ashjournal.com). Fifty percent of the invited population sample attended the survey. Comparison of attendees and nonattendees on the basis of previous hypertension-related diagnoses, current medication, and socioeconomic variables showed the two groups to be comparable

Discussion

Although arterial hypertension is well recognized as an important factor increasing the risk of cardiovascular disease, the knowledge of its prevalence and the outcome of clinical treatment are sparse and imprecise. There are few nationally representative surveys, and all published studies of prevalence are based on screening BP measured a few times on one occasion.5, 6 Such few measurements are for a number of reasons likely to overestimate BP and thereby the prevalence of hypertension and to

Conclusion

The rate of controlled BP by antihypertensive treatment in the present population based study of clinical practice is comparable with the best reported from community surveys¹⁶ and clinical trials.²⁰ In our opinion, the Danish Health Care system, which is easily accessible, financed by taxation and thus free of other cost to all citizens, is part of an explanation for the favorable results of antihypertensive treatment. Our data, however, still demonstrate insufficient detection of arterial

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: This study was funded by Apotekerfonden of 1991, The Danish Heart Foundation, The University of Southern Denmark, the County of Funen, and to a smaller extent by Pfizer, Novartis, Boehringer-Ingelheim, Solvay, and Sanofi-Synthelabo. Dr. Hallas has received research Grants from Novartis, Nycomed, and Merck Sharp & Dohme, and fees for teaching from Astra-Zeneca, Nycomed, Pfizer, and the Danish Association of Pharmaceutical Industry.

: Supplemental Material is available at www.ashjournal.com.

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Research articlePrevalence, awareness, and control of arterial hypertension in Denmark

Abstract

Introduction

Section snippets

Methods

Results

Discussion

Conclusion

Lancet

Lancet

J Clin Epidemiol

World health report 2002; reducing risk, promoting healthy life

Effect of different blood-pressure-lowering regimens on major cardiovascular events: results of prospectively-designed overviews of randomised trails

Lancet

Systolic and diastolic blood pressure control in antihypertensive drug trials

J Hypertens

Worldwide prevalence of hypertension: a systematic review

J Hypertens

Trends in the prevalence, awareness, treatment and control of hypertension in the US adult population

Hypertension

Awareness, treatment and control of hypertension in DenmarkThe Inter99 study

Blood Press

Validation of A&D UA-676 device for self-measurement of blood pressure

Blood Press Monitor

J Hypertens

Research article
Prevalence, awareness, and control of arterial hypertension in Denmark