Factors influencing blood pressure control in patients with atrial fibrillation and hypertension in Australian primary care
ObjectiveThis study explored factors that may influence blood pressure (BP) control in patients with atrial fibrillation (AF) with hypertension.MethodsCross-sectional retrospective analysis of the MedicineInsight database which includes de-identified electronic health records from general practices...
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| Veröffentlicht in: | Heart (British Cardiac Society) 2024-01, Vol.110 (2), p.94-100 |
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| creator | Trivedi, Ritu Marschner, Simone Shaw, Tim Min, Haeri Yue, Jason Kazi, Samia Nguyen, Tu Ng Laranjo, Liliana Chow, Clara K |
| description | ObjectiveThis study explored factors that may influence blood pressure (BP) control in patients with atrial fibrillation (AF) with hypertension.MethodsCross-sectional retrospective analysis of the MedicineInsight database which includes de-identified electronic health records from general practices (GPs) across Australia. BP control was assessed in patients with diagnosed AF and hypertension (controlled BP defined as |
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BP control was assessed in patients with diagnosed AF and hypertension (controlled BP defined as <140/90 mm Hg). We explored BP control, factors influencing BP control and likelihood of receiving guideline-recommended treatment.Results34 815 patients with AF and hypertension were included; mean age was 76.9 (10.2 SD) years and 46.2% were female. 38.0% had uncontrolled BP. Women (OR 0.72; 95% CI 0.68, 0.76; p<0.001) and adults ≥75 years (OR 0.78; 95% CI 0.70, 0.86; p<0.001) were less likely to have controlled BP. Greater continuity of care (CoC; that is, visits with the same clinician) and having frequent GP visits were associated with higher odds of controlled BP (model 1: CoC, OR 1.29; 95% CI 1.20, 1.40, p<0.001; GP visits, OR 1.71; 95% CI 1.58, 1.85, p<0.001) and a greater likelihood of being prescribed ≥2 types of BP-lowering medicines (model 2: CoC, OR 1.12; 95% CI 1.03, 1.23; p=0.011; GP visits, OR 1.80; 95% CI 1.63, 1.98; p<0.001).ConclusionsUncontrolled BP was more likely in women and adults ≥75 years. Patients who had frequent GP visits with the same clinician were more likely to have BP controlled and receive guideline-recommended antihypertensive treatment. This suggests that targeting these primary care factors could potentially improve BP control and subsequently reduce stroke risk in patients with AF.]]></description><identifier>ISSN: 1355-6037</identifier><identifier>ISSN: 1468-201X</identifier><identifier>EISSN: 1468-201X</identifier><identifier>DOI: 10.1136/heartjnl-2023-322602</identifier><identifier>PMID: 37474252</identifier><language>eng</language><publisher>England: BMJ Publishing Group Ltd and British Cardiovascular Society</publisher><subject>Adult ; Age ; Aged ; Antihypertensive Agents - pharmacology ; Antihypertensive Agents - therapeutic use ; Antihypertensives ; Arrhythmias and Sudden Death ; arrhythmias, cardiac ; atrial fibrillation ; Atrial Fibrillation - diagnosis ; Atrial Fibrillation - drug therapy ; Atrial Fibrillation - epidemiology ; Australia - epidemiology ; Blood pressure ; Blood Pressure - physiology ; Body mass index ; Cardiac arrhythmia ; Comorbidity ; Cross-Sectional Studies ; Diabetes ; Electronic health records ; Female ; Females ; Heart failure ; Humans ; Hypertension ; Hypertension - complications ; Hypertension - drug therapy ; Hypertension - epidemiology ; hypertension, pulmonary ; Kidney diseases ; Male ; Patients ; Primary care ; Primary Health Care ; Regression analysis ; Retrospective Studies ; Risk Factors ; Socioeconomic factors ; Socioeconomic status ; Stroke ; Variables</subject><ispartof>Heart (British Cardiac Society), 2024-01, Vol.110 (2), p.94-100</ispartof><rights>Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2023 Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2023 Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. 2023</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b506t-3290a730b4a4de538973dc596c76c7e031d00dc998baaec2ea947387a4a93f0c3</citedby><cites>FETCH-LOGICAL-b506t-3290a730b4a4de538973dc596c76c7e031d00dc998baaec2ea947387a4a93f0c3</cites><orcidid>0000-0003-1020-3402 ; 0000-0002-8836-8920 ; 0000-0002-5128-3202 ; 0000-0003-4693-0038 ; 0000-0002-5484-9144 ; 0000-0001-6976-5835 ; 0000-0002-9928-5290</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10803991/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10803991/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,27922,27923,53789,53791</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37474252$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Trivedi, Ritu</creatorcontrib><creatorcontrib>Marschner, Simone</creatorcontrib><creatorcontrib>Shaw, Tim</creatorcontrib><creatorcontrib>Min, Haeri</creatorcontrib><creatorcontrib>Yue, Jason</creatorcontrib><creatorcontrib>Kazi, Samia</creatorcontrib><creatorcontrib>Nguyen, Tu Ng</creatorcontrib><creatorcontrib>Laranjo, Liliana</creatorcontrib><creatorcontrib>Chow, Clara K</creatorcontrib><title>Factors influencing blood pressure control in patients with atrial fibrillation and hypertension in Australian primary care</title><title>Heart (British Cardiac Society)</title><addtitle>Heart</addtitle><addtitle>Heart</addtitle><description><![CDATA[ObjectiveThis study explored factors that may influence blood pressure (BP) control in patients with atrial fibrillation (AF) with hypertension.MethodsCross-sectional retrospective analysis of the MedicineInsight database which includes de-identified electronic health records from general practices (GPs) across Australia. BP control was assessed in patients with diagnosed AF and hypertension (controlled BP defined as <140/90 mm Hg). We explored BP control, factors influencing BP control and likelihood of receiving guideline-recommended treatment.Results34 815 patients with AF and hypertension were included; mean age was 76.9 (10.2 SD) years and 46.2% were female. 38.0% had uncontrolled BP. Women (OR 0.72; 95% CI 0.68, 0.76; p<0.001) and adults ≥75 years (OR 0.78; 95% CI 0.70, 0.86; p<0.001) were less likely to have controlled BP. Greater continuity of care (CoC; that is, visits with the same clinician) and having frequent GP visits were associated with higher odds of controlled BP (model 1: CoC, OR 1.29; 95% CI 1.20, 1.40, p<0.001; GP visits, OR 1.71; 95% CI 1.58, 1.85, p<0.001) and a greater likelihood of being prescribed ≥2 types of BP-lowering medicines (model 2: CoC, OR 1.12; 95% CI 1.03, 1.23; p=0.011; GP visits, OR 1.80; 95% CI 1.63, 1.98; p<0.001).ConclusionsUncontrolled BP was more likely in women and adults ≥75 years. Patients who had frequent GP visits with the same clinician were more likely to have BP controlled and receive guideline-recommended antihypertensive treatment. This suggests that targeting these primary care factors could potentially improve BP control and subsequently reduce stroke risk in patients with AF.]]></description><subject>Adult</subject><subject>Age</subject><subject>Aged</subject><subject>Antihypertensive Agents - pharmacology</subject><subject>Antihypertensive Agents - therapeutic use</subject><subject>Antihypertensives</subject><subject>Arrhythmias and Sudden Death</subject><subject>arrhythmias, cardiac</subject><subject>atrial fibrillation</subject><subject>Atrial Fibrillation - diagnosis</subject><subject>Atrial Fibrillation - drug therapy</subject><subject>Atrial Fibrillation - epidemiology</subject><subject>Australia - epidemiology</subject><subject>Blood pressure</subject><subject>Blood Pressure - physiology</subject><subject>Body mass index</subject><subject>Cardiac arrhythmia</subject><subject>Comorbidity</subject><subject>Cross-Sectional Studies</subject><subject>Diabetes</subject><subject>Electronic health records</subject><subject>Female</subject><subject>Females</subject><subject>Heart failure</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Hypertension - complications</subject><subject>Hypertension - drug therapy</subject><subject>Hypertension - epidemiology</subject><subject>hypertension, pulmonary</subject><subject>Kidney diseases</subject><subject>Male</subject><subject>Patients</subject><subject>Primary care</subject><subject>Primary Health Care</subject><subject>Regression analysis</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Socioeconomic factors</subject><subject>Socioeconomic status</subject><subject>Stroke</subject><subject>Variables</subject><issn>1355-6037</issn><issn>1468-201X</issn><issn>1468-201X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>9YT</sourceid><sourceid>ACMMV</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNp9kl1rFDEUhgdRbK3-A5GAN96MPfmYSXIlpVgVCr2x0LtwJpPpZplN1iRTKf55s-y2flwUAgknz3lzXvI2zVsKHynl_enKYSrrMLcMGG85Yz2wZ80xFb2qJXrzvJ5517U9cHnUvMp5DQBCq_5lc8SlkIJ17Lj5dYG2xJSJD9O8uGB9uCXDHONItsnlvCRHbAwlxbkiZIvFu1Ay-enLimBJHmcy-SH5ea5XMRAMI1ndb10qLuRdoXadLbkknD1WgeQ3mO6JxeReNy8mnLN7c9hPmuuLz9_Pv7aXV1--nZ9dtkMHfanWNKDkMAgUo-u40pKPttO9lXU54HQEGK3WakB0ljnUQnIlUaDmE1h-0nza626XYeNGWw3UacxhFBPRm39vgl-Z23hnKCjgWtOq8OGgkOKPxeViNj5bVz0HF5dsmBIUGHAOFX3_H7qOSwrVn2G6k4pyVqd7ilJc95J3SlRK7CmbYs7JTY8zUzC7EJiHEJhdCMw-BLXt3d9-H5sefr0CsAeGzfrPw09q_gbIVcH0</recordid><startdate>20240101</startdate><enddate>20240101</enddate><creator>Trivedi, Ritu</creator><creator>Marschner, Simone</creator><creator>Shaw, Tim</creator><creator>Min, Haeri</creator><creator>Yue, Jason</creator><creator>Kazi, Samia</creator><creator>Nguyen, Tu Ng</creator><creator>Laranjo, Liliana</creator><creator>Chow, Clara K</creator><general>BMJ Publishing Group Ltd and British Cardiovascular Society</general><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group</general><scope>9YT</scope><scope>ACMMV</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-1020-3402</orcidid><orcidid>https://orcid.org/0000-0002-8836-8920</orcidid><orcidid>https://orcid.org/0000-0002-5128-3202</orcidid><orcidid>https://orcid.org/0000-0003-4693-0038</orcidid><orcidid>https://orcid.org/0000-0002-5484-9144</orcidid><orcidid>https://orcid.org/0000-0001-6976-5835</orcidid><orcidid>https://orcid.org/0000-0002-9928-5290</orcidid></search><sort><creationdate>20240101</creationdate><title>Factors influencing blood pressure control in patients with atrial fibrillation and hypertension in Australian primary care</title><author>Trivedi, Ritu ; Marschner, Simone ; Shaw, Tim ; Min, Haeri ; Yue, Jason ; Kazi, Samia ; Nguyen, Tu Ng ; Laranjo, Liliana ; Chow, Clara K</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b506t-3290a730b4a4de538973dc596c76c7e031d00dc998baaec2ea947387a4a93f0c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adult</topic><topic>Age</topic><topic>Aged</topic><topic>Antihypertensive Agents - pharmacology</topic><topic>Antihypertensive Agents - therapeutic use</topic><topic>Antihypertensives</topic><topic>Arrhythmias and Sudden Death</topic><topic>arrhythmias, cardiac</topic><topic>atrial fibrillation</topic><topic>Atrial Fibrillation - diagnosis</topic><topic>Atrial Fibrillation - drug therapy</topic><topic>Atrial Fibrillation - epidemiology</topic><topic>Australia - epidemiology</topic><topic>Blood pressure</topic><topic>Blood Pressure - physiology</topic><topic>Body mass index</topic><topic>Cardiac arrhythmia</topic><topic>Comorbidity</topic><topic>Cross-Sectional Studies</topic><topic>Diabetes</topic><topic>Electronic health records</topic><topic>Female</topic><topic>Females</topic><topic>Heart failure</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Hypertension - complications</topic><topic>Hypertension - drug therapy</topic><topic>Hypertension - epidemiology</topic><topic>hypertension, pulmonary</topic><topic>Kidney diseases</topic><topic>Male</topic><topic>Patients</topic><topic>Primary care</topic><topic>Primary Health Care</topic><topic>Regression analysis</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Socioeconomic factors</topic><topic>Socioeconomic status</topic><topic>Stroke</topic><topic>Variables</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Trivedi, Ritu</creatorcontrib><creatorcontrib>Marschner, Simone</creatorcontrib><creatorcontrib>Shaw, Tim</creatorcontrib><creatorcontrib>Min, Haeri</creatorcontrib><creatorcontrib>Yue, Jason</creatorcontrib><creatorcontrib>Kazi, Samia</creatorcontrib><creatorcontrib>Nguyen, Tu Ng</creatorcontrib><creatorcontrib>Laranjo, Liliana</creatorcontrib><creatorcontrib>Chow, Clara K</creatorcontrib><collection>BMJ Open Access Journals</collection><collection>BMJ Journals:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Science Database (ProQuest)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Heart (British Cardiac Society)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Trivedi, Ritu</au><au>Marschner, Simone</au><au>Shaw, Tim</au><au>Min, Haeri</au><au>Yue, Jason</au><au>Kazi, Samia</au><au>Nguyen, Tu Ng</au><au>Laranjo, Liliana</au><au>Chow, Clara K</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Factors influencing blood pressure control in patients with atrial fibrillation and hypertension in Australian primary care</atitle><jtitle>Heart (British Cardiac Society)</jtitle><stitle>Heart</stitle><addtitle>Heart</addtitle><date>2024-01-01</date><risdate>2024</risdate><volume>110</volume><issue>2</issue><spage>94</spage><epage>100</epage><pages>94-100</pages><issn>1355-6037</issn><issn>1468-201X</issn><eissn>1468-201X</eissn><abstract><![CDATA[ObjectiveThis study explored factors that may influence blood pressure (BP) control in patients with atrial fibrillation (AF) with hypertension.MethodsCross-sectional retrospective analysis of the MedicineInsight database which includes de-identified electronic health records from general practices (GPs) across Australia. BP control was assessed in patients with diagnosed AF and hypertension (controlled BP defined as <140/90 mm Hg). We explored BP control, factors influencing BP control and likelihood of receiving guideline-recommended treatment.Results34 815 patients with AF and hypertension were included; mean age was 76.9 (10.2 SD) years and 46.2% were female. 38.0% had uncontrolled BP. Women (OR 0.72; 95% CI 0.68, 0.76; p<0.001) and adults ≥75 years (OR 0.78; 95% CI 0.70, 0.86; p<0.001) were less likely to have controlled BP. Greater continuity of care (CoC; that is, visits with the same clinician) and having frequent GP visits were associated with higher odds of controlled BP (model 1: CoC, OR 1.29; 95% CI 1.20, 1.40, p<0.001; GP visits, OR 1.71; 95% CI 1.58, 1.85, p<0.001) and a greater likelihood of being prescribed ≥2 types of BP-lowering medicines (model 2: CoC, OR 1.12; 95% CI 1.03, 1.23; p=0.011; GP visits, OR 1.80; 95% CI 1.63, 1.98; p<0.001).ConclusionsUncontrolled BP was more likely in women and adults ≥75 years. Patients who had frequent GP visits with the same clinician were more likely to have BP controlled and receive guideline-recommended antihypertensive treatment. This suggests that targeting these primary care factors could potentially improve BP control and subsequently reduce stroke risk in patients with AF.]]></abstract><cop>England</cop><pub>BMJ Publishing Group Ltd and British Cardiovascular Society</pub><pmid>37474252</pmid><doi>10.1136/heartjnl-2023-322602</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0003-1020-3402</orcidid><orcidid>https://orcid.org/0000-0002-8836-8920</orcidid><orcidid>https://orcid.org/0000-0002-5128-3202</orcidid><orcidid>https://orcid.org/0000-0003-4693-0038</orcidid><orcidid>https://orcid.org/0000-0002-5484-9144</orcidid><orcidid>https://orcid.org/0000-0001-6976-5835</orcidid><orcidid>https://orcid.org/0000-0002-9928-5290</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Age Aged Antihypertensive Agents - pharmacology Antihypertensive Agents - therapeutic use Antihypertensives Arrhythmias and Sudden Death arrhythmias, cardiac atrial fibrillation Atrial Fibrillation - diagnosis Atrial Fibrillation - drug therapy Atrial Fibrillation - epidemiology Australia - epidemiology Blood pressure Blood Pressure - physiology Body mass index Cardiac arrhythmia Comorbidity Cross-Sectional Studies Diabetes Electronic health records Female Females Heart failure Humans Hypertension Hypertension - complications Hypertension - drug therapy Hypertension - epidemiology hypertension, pulmonary Kidney diseases Male Patients Primary care Primary Health Care Regression analysis Retrospective Studies Risk Factors Socioeconomic factors Socioeconomic status Stroke Variables |
| title | Factors influencing blood pressure control in patients with atrial fibrillation and hypertension in Australian primary care |
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