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November 5, 2014BMC Public Health27 citationsOpen Access

Identifying predictors of blood pressure control in the Lebanese population - a national, multicentric survey – I-PREDICT

SMSamir MallatSSSerena Abu SamraFYF. Younes

Key Result

Diabetes was a significant predictor of poor blood pressure control at 6 months (OR 0.15), whereas early blood pressure control and combination therapy were significant predictors of better control.

Study Design

Type

Observational (n=988)

Multicenter

Yes

Structured PICO

What are the predictors of blood pressure control in Lebanese patients with newly diagnosed or uncontrolled hypertension?

P
Population
988 adults (≥18 years) with newly diagnosed or uncontrolled hypertension on medications, 55% male, based in Lebanon. Exclusion criteria: pregnancy, lactation, secondary hypertension, or participation in another study.
O
Outcome
Blood pressure control (<140/90 mm Hg, or <130/80 mm Hg for patients with diabetes and chronic kidney disease) at 6 months follow-upsurrogate

In a Lebanese cohort, early blood pressure control and combination therapy were strong predictors of achieving BP targets at 6 months, whereas diabetes significantly hindered control.

Main Result

Effect estimate: OR 0.15 (95% CI 0.10-0.24)

p-value: p=<0.001

Limitations

  • Potential sampling bias at the level of physicians' and patients' selection
  • Assessment of blood pressure control was based solely on clinic visits, which may introduce a white-coat effect
  • Inability to retrieve data on advancing age, a known predictor of poor blood pressure control
  • Sampling bias at physician and patient selection levels
  • Assessment of BP based on clinic visits (white coat effect)
  • Inability to retrieve advancing age data

Abstract

BACKGROUND: Blood Pressure (BP) is not well controlled and factors that predict BP control are not well identified in Lebanon. Improvement of hypertension management requires an understanding of patients' characteristics and factors associated with uncontrolled BP. This national, multicentric, observational prospective study was designed to determine the predictors of BP control in patients followed up to 6 months. METHODS: I-PREDICT study was conducted on 988 patients with newly diagnosed or uncontrolled hypertension. Socio-demographic and clinical characteristics were analyzed. The level of agreement between doctors' perceptions on BP control status and JNC VII guidelines was analyzed. RESULTS: The predictor associated with poor BP control was diabetes (OR = 0.17, CI = 0.10-0.28 at month-1; OR = 0.15, CI = 0.10-0.24 at month-6). The predictors associated with better BP control at month-6 were the early control of BP at month-1 (OR = 10.39, CI = 6.18-17.47) and combination therapy prescribed at baseline and month-1 (OR = 15.14, CI = 1.09-208.46, P = 0.04). In the sub-group of diabetes, the predictors that were associated with better BP control at 6 months were following diet at V1 (OR = 2.27, CI = 1.01 to 5.12) and BP control at V2 (OR = 7.34, CT = 3.83 to 14.07). The predictors that were associated with poor BP control at 6 months were middle economic class (OR = 0.036, CI = 0.16-0.94) and upper economic class (OR = 0.036; CI = 0.13-0.93).The rate of BP control was significantly higher at month 6 versus month 1 (67.52% vs 44.08%, P = 0.001). Additional analysis showed poor agreement between the doctors' perceptions on BP control status and the guidelines. CONCLUSIONS: Reaching an early BP control and combination therapy were significant predictors of better BP control, whereas diabetes was a significant predictor of poor BP control. A poor agreement between JNC VII guidelines and clinical practice was observed. I-PREDICT study identified factors that can be targeted for improving BP control.

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Cite This Study

Mallat et al. (2014) conducted an observational in Newly diagnosed or uncontrolled hypertension (n=988). Anti-hypertensive therapy was evaluated on Blood pressure control at 6 months (predictor: diabetes) (OR 0.15, 95% CI 0.10-0.24, p=<0.001). Diabetes was a significant predictor of poor blood pressure control at 6 months (OR 0.15), whereas early blood pressure control and combination therapy were significant predictors of better control.

synapsesocial.com/papers/6a1c2b491567d2fc4d5fb3f6https://doi.org/10.1186/1471-2458-14-1142
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