Prevalence of pharmacological control of arterial hypertension by ambulatory blood pressure measurement (ABPM) findings

Abstract

Introduction: Arterial hypertension (AHT) is one of the most prevalent chronic non-transmittable diseases and the main cause of cardiovascular death worldwide (World Health Organization, 2021). Adequate control of blood pressure levels is the best therapeutic measure to manage and prevent hypertension-related complications. In the Dominican Republic, there is insufficient and unreliable data related to pharmacological control through ambulatory blood pressure measurement (ABPM).

Methods: Cross-sectional and retrospective study, in which the results of 380 patients, who underwent an ABPM, were analyzed to determine if their blood pressure levels were within therapeutic control. The study was conducted between March 2022 and May 2022. The diagnostic criteria to determine blood pressure control were used from the guidelines of the Specialized Diagnostic Center (CEDISA), and included being older than 18 and having a study duration longer than 18 hours. Likewise, we excluded pregnant patients, patients diagnosed with heart failure, or patients taking triple antihypertensive therapy. For the data summary, we used mean and standard deviation. For statistical testing, we performed a Shapiro-Wilk normality test, and a two-tailed Student's t-test was used to assess the mean difference for which a value of p<0.05 was chosen to demonstrate significance. We performed a Bonferroni correction to adjust the significance value using the mean blood pressure in the repeated measures for the t-test, which reduced the significance from 0.05 to 0.016.

Results: The point prevalence of adequate pharmacological control was 44.2% (95% CI 39.21% to 49.19%). The mean systolic blood pressure of controlled patients was 117.8 (±7.5), while that of un-controlled patients was 140.8 (±14.5). Between controlled and uncontrolled patients, the drugs most frequently used for managing hypertension were angiotensin II, receptor antagonists. There is a statistically significant difference between the mean 24-hour and daytime systolic blood pressure between males and females (p. 0.0016 and p. 0.0007, respectively) and 24-hour, daytime, and nighttime systolic blood pressure between controlled and uncontrolled patients (p. 0.000, p. 0.000, p 0.000, respectively)

Discussion: The prevalence of adequate pharmacological control in patients suffering from arterial hypertension encompasses 168 patients of the 380 studied, so it is evident that the remaining 212 patients, even when diagnosed, have not managed to obtain controlled blood pressure levels. The study was limited by not being able to investigate the treatment specifications and other risk factors. Regardless of these issues, the study obtained the desired sample size; therefore, it can establish the study’s reported AHT control prevalence as a direct measure of hypertensive patients in the Dominican Republic not being adequately controlled.

Keywords: arterial hypertension, prevalence, pharmacological control, ABPM, continuous measurement