Skip to main content
Canadian Family Physician logoLink to Canadian Family Physician
. 2003 Oct;49:1323–1331.

Markers of loss of control of hypertension.

Richard Ian Casson 1, Will D King 1, Noah Marshall S Godwin 1
PMCID: PMC2214130  PMID: 14594101

Abstract

OBJECTIVE: To identify markers for loss of control of hypertension. DESIGN: Questionnaire administered to patients who had been monitored for 18 months and had had their blood pressure (BP) measured many times. SETTING: Fifty family practices in southeastern Ontario. PARTICIPANTS: Three hundred eighty-five adults with essential hypertension that was initially stable and controlled by medication. MAIN OUTCOME MEASURES: Change in BP (from baseline to mean of three measurements over 18 months) and proportion of patients with BP exceeding threshold values at most follow-up visits. RESULTS: Higher income was associated with an increase in diastolic BP; poor adherence to medication regimens and higher life stress were associated with increases in systolic BP Stress also led to a twofold increase in risk of exceeding BP thresholds. Other factors under study were not related to loss of control. CONCLUSION: Adherence to medication regimens, higher income, and life stress were the only factors associated with elevated BP or loss of control in previously controlled hypertension.

Full Text

The Full Text of this article is available as a PDF (263.3 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abbott D., Campbell N., Carruthers-Czyzewski P., Chockalingam A., David M., Dunkley G., Ellis E., Fodor J. G., McKay D., Ramsden V. R. Guidelines for measurement of blood pressure, follow-up, and lifestyle counselling. Canadian Coalition for High Blood Pressure Prevention and Control. Can J Public Health. 1994 Sep-Oct;85 (Suppl 2):S29–S43. [PubMed] [Google Scholar]
  2. Armitage P., Fox W., Rose G. A., Tinker C. M. The variability of measurements of casual blood pressure. II. Survey experience. Clin Sci. 1966 Apr;30(2):337–344. [PubMed] [Google Scholar]
  3. Berlowitz D. R., Ash A. S., Hickey E. C., Friedman R. H., Glickman M., Kader B., Moskowitz M. A. Inadequate management of blood pressure in a hypertensive population. N Engl J Med. 1998 Dec 31;339(27):1957–1963. doi: 10.1056/NEJM199812313392701. [DOI] [PubMed] [Google Scholar]
  4. Brueren M. M., Petri H., van Weel C., van Ree J. W. How many measurements are necessary in diagnosing mild to moderate hypertension? Fam Pract. 1997 Apr;14(2):130–135. doi: 10.1093/fampra/14.2.130. [DOI] [PubMed] [Google Scholar]
  5. Buck C. W., Donner A. P. Blood pressure control in hypertensives--a model for the study of life events. J Chronic Dis. 1984;37(4):247–253. doi: 10.1016/0021-9681(84)90132-2. [DOI] [PubMed] [Google Scholar]
  6. Caldwell J. R., Theisen V., Kaunisto C. A., Reddy P. J., Smythe P. S., Smith D. W. Psychosocial factors influence control of moderate and severe hypertension. Soc Sci Med. 1983;17(12):773–782. doi: 10.1016/0277-9536(83)90028-x. [DOI] [PubMed] [Google Scholar]
  7. Campbell N. R., Ashley M. J., Carruthers S. G., Lacourcière Y., McKay D. W. Lifestyle modifications to prevent and control hypertension. 3. Recommendations on alcohol consumption. Canadian Hypertension Society, Canadian Coalition for High Blood Pressure Prevention and Control, Laboratory Centre for Disease Control at Health Canada, Heart and Stroke Foundation of Canada. CMAJ. 1999 May 4;160(9 Suppl):S13–S20. [PMC free article] [PubMed] [Google Scholar]
  8. Cléroux J., Feldman R. D., Petrella R. J. Lifestyle modifications to prevent and control hypertension. 4. Recommendations on physical exercise training. Canadian Hypertension Society, Canadian Coalition for High Blood Pressure Prevention and Control, Laboratory Centre for Disease Control at Health Canada, Heart and Stroke Foundation of Canada. CMAJ. 1999 May 4;160(9 Suppl):S21–S28. [PMC free article] [PubMed] [Google Scholar]
  9. Degoulet P., Menard J., Vu H. A., Golmard J. L., Devries C., Chatellier G., Plouin P. F. Factors predictive of attendance at clinic and blood pressure control in hypertensive patients. Br Med J (Clin Res Ed) 1983 Jul 9;287(6385):88–93. doi: 10.1136/bmj.287.6385.88. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Fahey T. P., Peters T. J. A general practice-based study examining the absolute risk of cardiovascular disease in treated hypertensive patients. Br J Gen Pract. 1996 Nov;46(412):655–659. [PMC free article] [PubMed] [Google Scholar]
  11. Feldman R. D., Campbell N., Larochelle P., Bolli P., Burgess E. D., Carruthers S. G., Floras J. S., Haynes R. B., Honos G., Leenen F. H. 1999 Canadian recommendations for the management of hypertension. Task Force for the Development of the 1999 Canadian Recommendations for the Management of Hypertension. CMAJ. 1999;161 (Suppl 12):S1–17. [PMC free article] [PubMed] [Google Scholar]
  12. Fodor J. G., Whitmore B., Leenen F., Larochelle P. Lifestyle modifications to prevent and control hypertension. 5. Recommendations on dietary salt. Canadian Hypertension Society, Canadian Coalition for High Blood Pressure Prevention and Control, Laboratory Centre for Disease Control at Health Canada, Heart and Stroke Foundation of Canada. CMAJ. 1999 May 4;160(9 Suppl):S29–S34. [PMC free article] [PubMed] [Google Scholar]
  13. Joffres M. R., Ghadirian P., Fodor J. G., Petrasovits A., Chockalingam A., Hamet P. Awareness, treatment, and control of hypertension in Canada. Am J Hypertens. 1997 Oct;10(10 Pt 1):1097–1102. doi: 10.1016/s0895-7061(97)00224-0. [DOI] [PubMed] [Google Scholar]
  14. Joshi P. P., Salkar R. G., Heller R. F. Determinants of poor blood pressure control in urban hypertensives of central India. J Hum Hypertens. 1996 May;10(5):299–303. [PubMed] [Google Scholar]
  15. Leiter L. A., Abbott D., Campbell N. R., Mendelson R., Ogilvie R. I., Chockalingam A. Lifestyle modifications to prevent and control hypertension. 2. Recommendations on obesity and weight loss. Canadian Hypertension Society, Canadian Coalition for High Blood Pressure Prevention and Control, Laboratory Centre for Disease Control at Health Canada, Heart and Stroke Foundation of Canada. CMAJ. 1999 May 4;160(9 Suppl):S7–12. [PMC free article] [PubMed] [Google Scholar]
  16. McAlister F. A., Levine M., Zarnke K. B., Campbell N., Lewanczuk R., Leenen F., Rabkin S., Wright J. M., Stone J., Feldman R. D. The 2000 Canadian recommendations for the management of hypertension: Part one--therapy. Can J Cardiol. 2001 May;17(5):543–559. [PubMed] [Google Scholar]
  17. Paffenbarger R. S., Jr, Wing A. L., Hyde R. T., Jung D. L. Physical activity and incidence of hypertension in college alumni. Am J Epidemiol. 1983 Mar;117(3):245–257. doi: 10.1093/oxfordjournals.aje.a113537. [DOI] [PubMed] [Google Scholar]
  18. Pavlik V. N., Hyman D. J., Vallbona C. Hypertension control in multi-ethnic primary care clinics. J Hum Hypertens. 1996 Sep;10 (Suppl 3):S19–S23. [PubMed] [Google Scholar]
  19. Peterson G. M., McLean S. Determinants of patient compliance and clinical response in general-practice treatment of hypertension. Med J Aust. 1982 Sep 4;2(5):230–232. doi: 10.5694/j.1326-5377.1982.tb124346.x. [DOI] [PubMed] [Google Scholar]
  20. Plasencia A., Ostfeld A. M., Gruber S. B. Effects of sex on differences in awareness, treatment, and control of high blood pressure. Am J Prev Med. 1988 Nov-Dec;4(6):315–326. [PubMed] [Google Scholar]
  21. Sackett D. L., Haynes R. B., Gibson E. S., Taylor D. W., Roberts R. S., Johnson A. L. Patient compliance with antihypertensive regimens. Patient Couns Health Educ. 1978 1st Quart;1(1):18–21. doi: 10.1016/s0738-3991(78)80033-0. [DOI] [PubMed] [Google Scholar]
  22. Samuelsson O. Hypertension in middle-aged men. Management, morbidity and prognostic factors during long-term hypertensive care. Acta Med Scand Suppl. 1985;702:1–79. [PubMed] [Google Scholar]
  23. Spence J. D., Barnett P. A., Linden W., Ramsden V., Taenzer P. Lifestyle modifications to prevent and control hypertension. 7. Recommendations on stress management. Canadian Hypertension Society, Canadian Coalition for High Blood Pressure Prevention and Control, Laboratory Centre for Disease Control at Health Canada, Heart and Stroke Foundation of Canada. CMAJ. 1999 May 4;160(9 Suppl):S46–S50. [PMC free article] [PubMed] [Google Scholar]
  24. Stockwell D. H., Madhavan S., Cohen H., Gibson G., Alderman M. H. The determinants of hypertension awareness, treatment, and control in an insured population. Am J Public Health. 1994 Nov;84(11):1768–1774. doi: 10.2105/ajph.84.11.1768. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Tomiak M., Gentleman J. F. Risk factors for hypertension as measured by the Canada Health Survey. Health Rep. 1993;5(4):419–428. [PubMed] [Google Scholar]
  26. Wacholder S. Binomial regression in GLIM: estimating risk ratios and risk differences. Am J Epidemiol. 1986 Jan;123(1):174–184. doi: 10.1093/oxfordjournals.aje.a114212. [DOI] [PubMed] [Google Scholar]
  27. Wagner E. H., James S. A., Beresford S. A., Strogatz D. S., Grimson R. C., Kleinbaum D. G., Williams C. A., Cutchin L. M., Ibrahim M. A. The Edgecombe County High Blood Pressure Control Program: I. Correlates of uncontrolled hypertension at baseline. Am J Public Health. 1984 Mar;74(3):237–242. doi: 10.2105/ajph.74.3.237. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Winickoff R. N., Murphy P. K. The persistent problem of poor blood pressure control. Arch Intern Med. 1987 Aug;147(8):1393–1396. [PubMed] [Google Scholar]

Articles from Canadian Family Physician are provided here courtesy of College of Family Physicians of Canada

RESOURCES