Gender differences and risk factor control in treated hypertensives - a national study in the primary health care of Sweden

The care of treated hypertensive (tHT) patients should aim to optimise the control of risk factors (RF) in order to lower the total cardiovascular (CV) risk. The aim of this cross-sectional survey of tHT from Sweden was to study gender differences in risk factor control from a representative sample in primary health care (PHC). In all, 5397 tHT (48% men), mean age 66 years, were collected from records by 227 GPs from September 2002 to November 2004. Data on individual risk factors were registered from consecutive patients at each centre and stored in a central database. The mean blood pressure was 147/82 mmHg, mean total cholesterol (TC) 5.4 mmol/L, and mean LDL-cholesterol (LDL-C) 3.2 mmol/L. The prevalence of hyperlipidemia (TC >5.0, LDL-C >3.0 mmol/L) was 72% and 67% respectively, left ventricular hypertrophy (LVH) 17%, diabetes 21%, microalbuminuria 21%, and smoking 15%. In all 33% of the tHT were also treated for hyperlipidemia with 40% and 46% fulfilling goal criteria for TC (<5 mmol/l) and LDL-C (<3 mmol/l), respectively. The proportion of all tHT with SBP <140 mmHg was 29% and with DBP<90 mmHg was 74%. A comparison between three different age groups < 56, 56–70, and >70 years showed that females >70 years were older and had a higher SBP, and those >56 years a higher LDL-C than corresponding males. Those had a higher DBP in the age group 56–70 years and also more diabetes, LVH (<70 years) and microalbuminuria than females. More women in the age group <56 years, and more men >70 years smoked. Females were more often treated with thiazide diuretics, and males were more often treated with ACE-inhibitors, calcium channel blockers, and lipid lowering treatment. The CV risk factors associated with tHT were prevalent, especially hyperlipidemia and hypertension in more than two thirds of the patients. Patients with treated hypertension should have a more optimal CV risk factor control in general, including lipid lowering and anti-hypertensive combination therapy. Gender differences in RF control should be minimised.