Risk factors of uncontrolled hypertension in hypertensive patients in the Tunisian population

Uncontrolled hypertension is associated with an increased risk of cardiovascular complications. Determining the factors of poor blood pressure control helps to set up more effective therapeutic strategies. The objective of our study was to identify factors associated with uncontrolled hypertension confirmed by ambulatory blood pressure monitoring (ABPM) in our population. We conducted a retrospective case-control study including patients who had an ABPM between January 2014 and June 2017. The diagnosis of uncontrolled hypertension was defined as a mean 24-hour BP ≥ 130/80 mmHg. We divided our patients into 2 groups: G1: patients with uncontrolled hypertension and G2: patients with controlled hypertension. The comparison between the 2 groups was carried out by chi 2 tests for univariate analysis and logistic regression for multivariate analysis. A total of 175 hypertensive patients were included, sex-ratio M/F = 0.9. The indication of ABPM was an uncontrolled hypertension in office in 143 cases (82%) and blood pressure control in 32 cases (18%). The prevalence of uncontrolled hypertension was 51%. The 24-hour BP was 151/87 mmHg in the G1 and 123/69 mmHg and G2 group ( P < 0.001). In univariate analysis, factors associated with poorly controlled hypertension were: male gender ( P = 0.002), smoking ( P = 0.018), personal history of chronic renal failure ( P = 0.027), presence of metabolic syndrome ( P = 0.008) and hyper glycaemia ( P = 0.01). In multivariate analysis, uncontrolled hypertension was associated with male gender ( P = 0.05), presence of metabolic syndrome ( P = 0.044), and low HDL cholesterol level ( P = 0.05). In our population, more than half of hypertensive patients were not adequately controlled. The main determinants of this poor control were: male gender and metabolic syndrome. Adequate care, by monitoring these factors, is essential for a better blood pressure control.