Arterial hypertension represents a major cause of cardiovascular morbidity and mortality, and affects approximately 1 billion individuals worldwide [
A large cross-sectional International Survey Evaluating microAlbuminuria Routinely by Cardiologists in patients with Hypertension (i-SEARCH) study was conducted in 2005-2006 in cardiology outpatient clinics in 26 countries world-wide as described previously [
All analyses were performed both globally and separately for the following 5 geographical regions: Northern Europe (Belgium, Germany, Sweden, Switzerland), Southern Europe (Greece, Italy, Spain, Turkey), North America (Canada), Middle East (Kuwait, Lebanon, Qatar, Saudi Arabia, United Arab Emirates) and Asia (Hong Kong, Indonesia, Korea, Singapore, Taiwan, Thailand, Vietnam). The analysis population comprised patients with no missing data for SBP/DBP and the respective metabolic parameter. A linear model was used to estimate the least square means of BMI, WC, HbA1c, LDL-cholesterol, HDL-cholesterol, triglycerides, and CRP for each level of SBP/DBP and by region. The model was adjusted for age and gender (BMI, WC, and CRP); for age, gender, and antidiabetic treatment (HbA1c); and for age, gender, and the presence of diabetes (LDL- and HDL-cholesterol, triglycerides). A logistic regression analysis was conducted to estimate the prevalence of diabetes for each level of SBP/DBP and region, adjusted for age and gender (predictive marginal probabilities). Continuous variables are depicted as adjusted means (least square means) ± standard deviations and categorical variables as percentages (95% confidence intervals).
Overall, mean patient age was 63.1 years out of which 52.8% were male. Mean SBP/DBP was 148.9/87.0 mmHg, and 76.3% of patients had uncontrolled blood pressure. Diabetes was present in 29.1% of patients with mean HbA1c of 6.8%. Mean LDL-cholesterol was 3.2 mmol/L, mean HDL-cholesterol 1.3 mmol/L, and mean triglycerides 1.8 mmol/L, and 49.0% of patients had hypercholesterolemia. MAU was present in 58.8% of patients, and mean CRP was 0.92 mg/dL. 38.8% of patients were present or past smokers, and 28.6% had a family history of a myocardial infarction. For concomitant cardiovascular disease and regional distribution of individual parameters, see Table
Patient characteristics.
Total | Northern Europe | Southern Europe | North America | Middle East | Asia | |
Age | 63.1 | 64.9 | 62.5 | 65.7 | 57.1 | 60.5 |
Gender (male, %) | 52.8 | 53.0 | 52.9 | 56.3 | 61.0 | 48.5 |
BMI (kg/m²) | 28.9 | 29.7 | 29.2 | 30.2 | 29.8 | 25.9 |
Waist circumference (cm) | 99.7 | 102.5 | 100.9 | 102.6 | 102.5 | 89.5 |
Systolic blood pressure (mmHg) | 148.9 | 151.5 | 148.6 | 144.3 | 156.6 | 145.1 |
Diastolic blood pressure (mmHg) | 87.0 | 87.7 | 87.7 | 81.4 | 92.0 | 85.6 |
Uncontrolled blood pressure (%)* | 76.3 | 82.1 | 75.6 | 64.9 | 87.9 | 69.5 |
Diabetes mellitus (%) | 29.1 | 33.9 | 27.4 | 30.9 | 33.8 | 21.7 |
HbA1c (%) | 6.8 | 6.7 | 6.7 | 6.7 | 7.9 | 7.1 |
LDL cholesterol (mmol/L) | 3.2 | 3.2 | 3.3 | 2.6 | 3.4 | 3.1 |
HDL cholesterol (mmol/L) | 1.3 | 1.5 | 1.3 | 1.3 | 1.1 | 1.3 |
Triglycerides (mmol/L) | 1.8 | 1.9 | 1.7 | 1.7 | 2.0 | 1.8 |
Hyperlipidemia (%) | 49.0 | 53.0 | 43.3 | 64.4 | 56.1 | 46.1 |
Smoking (current/past; %) | 38.8 | 36.4 | 41.8 | 55.7 | 44.9 | 28.5 |
Family history of MI (%) | 28.6 | 22.0 | 29.6 | 40.0 | 25.5 | 36.3 |
Microalbuminuria (%) | 58.6 | 54.3 | 59.6 | 53.8 | 71.6 | 64.7 |
CRP (mg/dL) | 0.92 | 1.02 | 0.91 | 0.54 | 0.91 | 0.49 |
Coronary artery disease (%) | 25.1 | 21.5 | 23.7 | 40.5 | 30.4 | 26.4 |
Congestive heart failure (%) | 6.4 | 6.3 | 6.7 | 5.5 | 8.3 | 6.0 |
Atrial fibrillation (%) | 9.3 | 9.5 | 11.1 | 11.7 | 4.7 | 4.0 |
Myocardial infarction (%) | 31.6 | 24.4 | 34.1 | 41.7 | 27.9 | 37.1 |
Ischemic stroke (%) | 5.1 | 24.7 | 5.5 | 5.6 | 4.4 | 14.6 |
Peripheral artery disease (%) | 4.6 | 6.1 | 5.0 | 5.7 | 4.7 | 0.5 |
Betablockers (%) | 48.7 | 59.7 | 40.2 | 44.8 | 52.5 | 48.1 |
Calcium Antagonists (%) | 36.0 | 30.3 | 31.9 | 43.4 | 36.7 | 53.6 |
ACE-Inhibitors (%) | 42.3 | 45.8 | 42.8 | 49.5 | 31.9 | 32.1 |
AT1-Rezeptorantagonists (%) | 35.8 | 30.1 | 41.3 | 31.1 | 47.9 | 34.4 |
Diuretics (%) | 9.9 | 10.9 | 10.5 | 8.0 | 10.7 | 7.4 |
*Uncontrolled blood pressure was defined as SBP/DBP ≥140/90 in non-diabetic and ≥130/80 in diabetic patients.
Globally, the mean BMI was higher in patients with SBP ≥180 versus <120 mmHg (29.5 versus 28.2 kg/m2), in patients with DBP ≥110 versus <90 mmHg (30.3 versus 28.5 kg/m2), and in patients with uncontrolled versus controlled blood pressure (29.4 versus 28.6 kg/m2) (
Blood pressure and BMI (kg/m2; mean ± SE; adjusted for age, gender).
Total | Northern Europe | Southern Europe | North America | Midde East | Asia | ||
SBP (mmHg) | |||||||
<120 | 28.2 (0.249) | 29.1 (0.487) | 28.4 (0.453) | 30.1 (0.601) | 28.3 (1.467) | 26.2 (0.474) | <0.0001 |
120–139 | 28.5 (0.086) | 29.1 (0.168) | 28.6 (0.132) | 30.4 (0.253) | 31.0 (0.647) | 26.4 (0.187) | <0.0001 |
140–159 | 28.8 (0.066) | 29.6 (0.108) | 29.0 (0.102) | 30.2 (0.222) | 29.7 (0.370) | 25.7 (0.158) | <0.0001 |
160–179 | 29.5 (0.105) | 30.2 (0.169) | 29.9 (0.165) | 30.2 (0.403) | 29.6 (0.474) | 25.7 (0.287) | <0.0001 |
≥180 | 29.5 (0.163) | 30.2 (0.249) | 30.2 (0.264) | 29.1 (0.763) | 30.0 (0.629) | 25.5 (0.445) | <0.0001 |
| <0.0001 | <0.0001 | <0.0001 | <0.0001 | 0.0126 | <0.0001 | |
DBP (mmHg) | |||||||
<90 | 28.5 (0.063) | 29.3 (0.110) | 28.6 (0.102) | 29.9 (0.176) | 29.7 (0.440) | 26.0 (0.144) | <0.0001 |
90–99 | 29.2 (0.082) | 30.1 (0.134) | 29.4 (0.124) | 30.5 (0.342) | 29.5 (0.395) | 25.7 (0.207) | <0.0001 |
100–109 | 29.5 (0.113) | 30.0 (0.187) | 30.2 (0.169) | 31.5 (0.548) | 30.4 (0.471) | 25.9 (0.276) | <0.0001 |
≥110 | 30.3 (0.227) | 30.8 (0.362) | 31.0 (0.350) | 31.9 (1.286) | 30.6 (0.793) | 26.3 (0.642) | <0.0001 |
| <0.0001 | <0.0001 | <0.0001 | <0.0001 | 0.0157 | <0.0001 | |
RR (mmHg) | |||||||
uncontrolled* | 29.4 (0.066) | 29.9 (0.085) | 29.5 (0.082) | 30.1 (0.190) | 29.8 (0.259) | 25.7 (0.132) | <0.0001 |
controlled** | 28.6 (0.061) | 28.9 (0.170) | 28.4 (0.134) | 30.3 (0.239) | 30.6 (0.650) | 26.2 (0.184) | <0.0001 |
| <0.0001 | <0.0001 | <0.0001 | <0.0001 | 0.0080 | <0.0001 |
*SBP/DBP ≥140/90 in non-diabetic and ≥130/80 in diabetic patients, **<140/90 in non-diabetic and <130/80 in diabetic patients.
Blood pressure and WC (cm ± SD, adjusted for age, gender).
Total | Northern Europe | Southern Europe | North America | Middle East | Asia | ||
SBP (mmHg) | |||||||
<120 | 97.5 (0.557) | 100.2 (1.028) | 98.5 (0.948) | 100.9 (1.254) | 96.9 (3.078) | 89.9 (0.994) | <0.0001 |
120–139 | 98.5 (0.218) | 100.3 (0.400) | 99.2 (0.314) | 102.1 (0.600) | 100.8 (1.536) | 90.6 (0.445) | <0.0001 |
140–159 | 99.6 (0.171) | 102.2 (0.268) | 100.3 (0.255) | 102.5 (0.548) | 101.0 (0.923) | 89.0 (0.392) | <0.0001 |
160–179 | 100.9 (0.244) | 103.4 (0.373) | 102.0 (0.364) | 102.4 (0.880) | 102.4 (1.070) | 89.0 (0.634) | <0.0001 |
≥180 | 101.2 (0.414) | 103.3 (0.603) | 103.4 (0.642) | 101.3 (1.816) | 104.6 (1.528) | 89.2 (1.067) | <0.0001 |
| <0.0001 | <0.0001 | <0.0001 | <0.0001 | 0.1275 | <0.0001 | |
DBP (mmHg) | |||||||
<90 | 98.8 (0.154) | 101.1 (0.256) | 99.5 (0.237) | 101.7 (0.405) | 100.1 (1.024) | 89.9 (0.334) | <0.0001 |
90–99 | 100.1 (0.198) | 103.1 (0.309) | 100.5 (0.287) | 102.5 (0.782) | 100.4 (0.924) | 89.0 (0.476) | <0.0001 |
100–109 | 101.3 (0.305) | 102.8 (0.485) | 103.4 (0.441) | 105.1 (1.417) | 105.6 (1.230) | 89.5 (0.716) | <0.0001 |
≥110 | 103.2 (0.607) | 105.1 (0.916) | 104.1 (0.891) | 107.4 (3.250) | 105.0 (2.041) | 89.7 (1.611) | <0.0001 |
| <0.0001 | <0.0001 | <0.0001 | <0.0001 | 0.0012 | <0.0001 | |
RR (mmHg) | |||||||
uncontrolled* | 100.7 (0.167) | 102.7 (0.201) | 101.2 (0.195) | 102.2 (0.445) | 102.1 (0.619) | 89.2 (0.311) | <0.0001 |
controlled** | 98.8 (0.149) | 100.1 (0.400) | 99.0 (0.315) | 102.1 (0.559) | 100.0 (1.523) | 90.2 (0.430) | <0.0001 |
| <0.0001 | <0.0001 | <0.0001 | <0.0001 | 0.0882 | <0.0001 |
*SBP/DBP ≥140/90 in non-diabetic and ≥130/80 in diabetic patients, **<140/90 in non-diabetic and <130/80 in diabetic patients.
The prevalence of diabetes was 28.4% in patients with an SBP <120 mmHg and 32.6% in patients with an SBP ≥180 mmHg (
Blood pressure and diabetes (% (95% CI), adjusted for age, and gender).
Total | Northern Europe | Southern Europe | North America | Middle East | Asia | ||
SBP (mmHg) | |||||||
<120 | 28.4 (24.78; 31.94) | 28.3 (21.79; 35.96) | 33.2 (26.56; 40.53) | 36.5 (27.70; 46.41) | 32.3 (14.11; 58.00) | 21.4 (15.72; 28.48) | <0.0001 |
120–139 | 27.3 (25.86; 28.65) | 33.7 (30.86; 36.77) | 25.7 (23.65; 27.94) | 33.6 (29.39; 38.16) | 33.9 (23.15; 46.63) | 22.7 (19.92; 25.83) | <0.0001 |
140–159 | 28.8 (27.69; 29.83) | 33.6 (31.77; 35.57) | 29.8 (28.12; 31.63) | 28.8 (25.21; 32.59) | 40.0 (33.26; 47.09) | 22.5 (20.07; 25.07) | <0.0001 |
160–179 | 30.4 (28.98; 31.89) | 37.4 (34.96; 33.96) | 31.4 (29.16; 33.84) | 32.7 (27.24; 38.59) | 32.1 (25.62; 39.44) | 21.0 (17.62; 24.84) | <0.0001 |
≥180 | 32.6 (30.12; 35.00) | 34.8 (31.08; 38.77) | 36.5 (32.50; 40.66) | 16.4 (9.30; 27.44) | 49.5 (38.68; 60.35) | 26.8 (20.84; 33.64) | <0.0001 |
| <0.0001 | 0.1571 | 0.0009 | 0.0491 | 0.1353 | 0.6222 | |
DBP (mmHg) | |||||||
<90 | 30.9 (29.95; 31.95) | 37.6 (35.77; 39.53) | 29.6 (27.97; 31.25) | 34.3 (31.51; 37.31) | 38.8 (31.44; 46.82) | 25.8 (23.58; 28.08) | <0.0001 |
90–99 | 27.9 (26.76; 29.14) | 34.2 (32.11; 36.36) | 29.2 (27.32; 31.08) | 25.3 (20.77; 30.55) | 34.4 (28.23; 41.10) | 21.2 (18.53; 24.24) | <0.0001 |
100–109 | 25.5 (23.70; 27.26) | 26.9 (23.92; 30.13) | 31.0 (28.16; 34.07) | 22.2 (14.84; 31.73) | 38.7 (30.21; 47.89) | 13.6 (10.43; 17.64) | <0.0001 |
≥110 | 28.1 (24.68; 31.55) | 31.3 (26.06; 37.12) | 33.3 (28.08; 38.99) | 18.4 (7.02; 40.17) | 42.7 (29.81; 56.68) | 16.7 (9.95; 26.69) | <0.0001 |
| <0.0001 | <0.0001 | 0.3635 | 0.0002 | 0.8877 | <0.0001 | |
RR (mmHg) | |||||||
uncontrolled* | 27.7 (26.73; 28.71) | 34.7 (33.30; 36.06) | 30.8 (29.48; 32.07) | 28.6 (25.81; 31.56) | 38.0 (33.68; 42.54) | 22.4 (20.55; 24.34) | <0.0001 |
controlled** | 30.4 (29.42; 31.34) | 34.3 (31.37; 37.33) | 27.1 (27.98; 29.40) | 35.4 (31.36; 39.70) | 37.1 (25.98; 49.82) | 22.9 (20.18; 25.96) | <0.0001 |
| 0.1783 | 0.8316 | 0.0497 | 0.0106 | 0.6824 | 0.6820 |
*SBP/DBP ≥140/90 in non-diabetic and ≥130/80 in diabetic patients, **<140/90 in non-diabetic and <130/80 in diabetic patients.
Blood pressure and HbA1c (% ± SD, adjusted for age, gender, and diabetes treatment).
Total | Northern Europe | Southern Europe | North America | Middle East | Asia | ||
SBP (mmHg) | |||||||
<120 | 6.7 (0.115) | 6.2 (0.202) | 6.4 (0.199) | 6.6 (0.214) | 6.4 (0.725) | 6.8 (0.257) | 0.4127 |
120–139 | 6.6 (0.047) | 6.4 (0.072) | 6.3 (0.081) | 6.4 (0.113) | 7.3 (0.348) | 6.7 (0.114) | 0.0073 |
140–159 | 6.8 (0.037) | 6.5 (0.049) | 6.5 (0.062) | 6.6 (0.111) | 7.3 (0.168) | 6.8 (0.102) | <0.0001 |
160–179 | 6.9 (0.052) | 6.6 (0.063) | 6.7 (0.084) | 6.6 (0.167) | 7.6 (0.187) | 6.9 (0.179) | <0.0001 |
≥180 | 7.0 (0.084) | 6.7 (0.102) | 6.9 (0.135) | 6.4 (0.402) | 8.0 (0.243) | 6.9 (0.292) | <0.0001 |
| <0.0001 | 0.0003 | 0.0012 | 0.4751 | 0.6808 | 0.7181 | |
DBP (mmHg) | |||||||
<90 | 6.8 (0.031) | 6.5 (0.043) | 6.4 (0.055) | 6.5 (0.074) | 7.2 (0.172) | 6.8 (0.080) | <0.0001 |
90–99 | 6.8 (0.045) | 6.5 (0.056) | 6.5 (0.069) | 6.6 (0.175) | 7.6 (0.180) | 6.7 (0.128) | <0.0001 |
100–109 | 6.9 (0.076) | 6.6 (0.096) | 6.8 (0.111) | 6.4 (0.312) | 8.0 (0.226) | 6.4 (0.243) | <0.0001 |
≥110 | 6.9 (0.172) | 6.7 (0.211) | 6.6 (0.288) | 7.7 (0.934) | 7.2 (0.489) | 7.2 (0.921) | 0.6603 |
| 0.0027 | 0.1605 | 0.0136 | 0.3190 | 0.3332 | 0.4885 | |
RR (mmHg) | |||||||
uncontrolled* | 6.8 (0.039) | 6.5 (0.035) | 6.6 (0.046) | 6.6 (0.088) | 7.6 (0.111) | 6.8 (0.082) | <0.0001 |
controlled** | 6.7 (0.030) | 6.3 (0.073) | 6.3 (0.079) | 6.5 (0.104) | 7.1 (0.316) | 6.7 (0.110) | 0.0075 |
| <0.0001 | 0.0004 | 0.0091 | 0.2444 | 0.3367 | 0.3114 |
*SBP/DBP ≥140/90 in non-diabetic and ≥130/80 in diabetic patients, **<140/90 in non-diabetic and <130/80 in diabetic patients.
The mean LDL-cholesterol was higher in patients with SBP ≥180 versus <120 mmHg (3.4 versus 2.9 mmol/L), in patients with DBP ≥110 versus <90 mmHg (3.5 versus 3.0 mmol/L), and in patients with uncontrolled versus controlled blood pressure (3.4 versus 3.0 mmoL) (
Blood pressure and LDL-Cholesterol (mmol/L ± SD, adjusted for age, gender, and diabetes).
Total | Northern Europe | Southern Europe | North America | Middle East | Asia | ||
SBP (mmHg) | |||||||
<120 | 2.9 (0.044) | 3.0 (0.088) | 3.0 (0.076) | 2.5 (0.109) | 2.8 (0.231) | 2.8 (0.093) | 0.0003 |
120–139 | 3.0 (0.048) | 3.1 (0.035) | 3.0 (0.028) | 2.4 (0.054) | 2.9 (0.121) | 2.9 (0.042) | <0.0001 |
140–159 | 3.2 (0.015) | 3.2 (0.025) | 3.2 (0.024) | 2.6 (0.053) | 3.4 (0.075) | 3.0 (0.038) | <0.0001 |
160–179 | 3.3 (0.020) | 3.3 (0.033) | 3.3 (0.032) | 2.7 (0.081) | 3.5 (0.080) | 3.3 (0.057) | <0.0001 |
≥180 | 3.4 (0.034) | 3.4 (0.055) | 3.5 (0.058) | 3.0 (0.153) | 3.9 (0.131) | 3.5 (0.096) | <0.0001 |
| <0.0001 | <0.0001 | <0.0001 | <0.0001 | 0.0005 | <0.0001 | |
DBP (mmHg) | |||||||
<90 | 3.0 (0.013) | 3.1 (0.022) | 3.1 (0.021) | 2.4 (0.037) | 3.0 (0.081) | 2.9 (0.031) | <0.0001 |
90–99 | 3.3 (0.016) | 3.3 (0.028) | 3.3 (0.027) | 2.8 (0.074) | 3.4 (0.073) | 3.1 (0.045) | <0.0001 |
100–109 | 3.4 (0.026) | 3.4 (0.047) | 3.4 (0.041) | 2.9 (0.141) | 3.9 (0.098) | 3.4 (0.069) | <0.0001 |
≥110 | 3.5 (0.049) | 3.5 (0.086) | 3.6 (0.080) | 3.9 (0.311) | 3.5 (0.169) | 3.6 (0.151) | 0.5736 |
| <0.0001 | <0.0001 | <0.0001 | <0.0001 | <0.0001 | <0.0001 | |
RR (mmHg) | |||||||
uncontrolled* | 3.4 (0.014) | 3.3 (0.019) | 3.3 (0.018) | 2.7 (0.042) | 3.5 (0.050) | 3.1 (0.029) | <0.0001 |
controlled** | 3.0 (0.012) | 3.0 (0.034) | 3.0 (0.027) | 2.4 (0.050) | 2.9 (0.115) | 2.9 (0.040) | <0.0001 |
| <0.0001 | <0.0001 | <0.0001 | <0.0001 | <0.0001 | <0.0001 |
*SBP/DBP ≥140/90 in non-diabetic and ≥130/80 in diabetic patients, **<140/90 in non-diabetic and <130/80 in diabetic patients.
Blood pressure and HDL-Cholesterol (mmol/L ± SD, adjusted for age, gender, and diabetes).
Total | Northern Europe | Southern Europe | North America | Middle East | Asia | ||
SBP (mmHg) | |||||||
<120 | 1.3 (0.025) | 1.4 (0.051) | 1.2 (0.044) | 1.4 (0.065) | 1.1 (0.135) | 1.3 (0.053) | 0.0498 |
120–139 | 1.3 (0.008) | 1.4 (0.015) | 1.3 (0.012) | 1.3 (0.024) | 1.1 (0.054) | 1.3 (0.018) | <0.0001 |
140–159 | 1.3 (0.007) | 1.5 (0.011) | 1.3 (0.010) | 1.3 (0.024) | 1.2 (0.034) | 1.3 (0.017) | <0.0001 |
160–179 | 1.3 (0.009) | 1.4 (0.014) | 1.3 (0.014) | 1.3 (0.035) | 1.1 (0.035) | 1.3 (0.025) | <0.0001 |
≥180 | 1.3 (0.016) | 1.5 (0.025) | 1.2 (0.026) | 1.3 (0.070) | 1.0 (0.059) | 1.3 (0.045) | <0.0001 |
| 0.3309 | 0.0558 | 0.1317 | 0.3366 | 0.6608 | 0.7711 | |
DBP (mmHg) | |||||||
<90 | 1.3 (0.005) | 1.4 (0.010) | 1.3 (0.009) | 1.3 (0.017) | 1.2 (0.038) | 1.3 (0.014) | <0.0001 |
90–99 | 1.3 (0.007) | 1.4 (0.012) | 1.3 (0.011) | 1.3 (0.033) | 1.2 (0.033) | 1.3 (0.020) | <0.0001 |
100–109 | 1.3 (0.011) | 1.4 (0.016) | 1.2 (0.014) | 1.3 (0.047) | 1.1 (0.034) | 1.2 (0.024) | <0.0001 |
≥110 | 1.3 (0.033) | 1.6 (0.057) | 1.2 (0.052) | 1.4 (0.208) | 1.0 (0.114) | 1.2 (0.102) | <0.0001 |
| 0.0222 | 0.0013 | 0.0904 | 0.7721 | 0.0188 | 0.6265 | |
RR (mmHg) | |||||||
uncontrolled* | 1.3 (0.006) | 1.5 (0.008) | 1.3 (0.008) | 1.3 (0.019) | 1.1 (0.022) | 1.3 (0.013) | <0.0001 |
controlled** | 1.3 (0.006) | 1.4 (0.016) | 1.3 (0.013) | 1.3 (0.023) | 1.1 (0.054) | 1.3 (0.019) | <0.0001 |
| 0.1340 | 0.0916 | 0.1632 | 0.9361 | 0.8361 | 0.8030 |
*SBP/DBP ≥140/90 in non-diabetic and ≥130/80 in diabetic patients, **<140/90 in non-diabetic and <130/80 in diabetic patients.
Blood pressure and triglycerides (mmol/L ± SD, adjusted for age, gender, and diabetes).
Total | Northern Europe | Southern Europe | North America | Middle East | Asia | ||
SBP (mmHg) | |||||||
<120 | 1.5 (0.037) | 1.6 (0.078) | 1.6 (0.068) | 1.5 (0.102) | 1.3 (0.206) | 1.7 (0.076) | 0.4212 |
120–139 | 1.7 (0.017) | 1.8 (0.033) | 1.6 (0.027) | 1.8 (0.054) | 1.7 (0.120) | 1.8 (0.038) | <0.0001 |
140–159 | 1.8 (0.014) | 1.9 (0.025) | 1.7 (0.023) | 1.7 (0.054) | 2.1 (0.075) | 1.9 (0.036) | <0.0001 |
160–179 | 1.9 (0.020) | 2.0 (0.033) | 1.8 (0.033) | 1.7 (0.085) | 2.2 (0.082) | 2.0 (0.055) | <0.0001 |
≥180 | 1.9 (0.034) | 2.0 (0.055) | 1.8 (0.057) | 1.9 (0.157) | 2.3 (0.134) | 2.2 (0.097) | 0.0054 |
| <0.0001 | <0.0001 | <0.0001 | 0.1658 | 0.0039 | 0.0008 | |
DBP (mmHg) | |||||||
<90 | 1.7 (0.012) | 1.8 (0.021) | 1.6 (0.020) | 1.7 (0.037) | 1.7 (0.078) | 1.8 (0.028) | <0.0001 |
90–99 | 1.9 (0.016) | 2.0 (0.028) | 1.8 (0.026) | 1.9 (0.074) | 2.2 (0.073) | 1.9 (0.042) | <0.0001 |
100–109 | 1.9 (0.027) | 2.0 (0.050) | 1.8 (0.044) | 2.0 (0.154) | 2.3 (0.108) | 2.1 (0.073) | <0.0001 |
≥110 | 1.9 (0.053) | 1.8 (0.089) | 1.9 (0.084) | 1.9 (0.342) | 2.4 (0.180) | 2.3 (0.161) | 0.0073 |
| <0.0001 | <0.0001 | <0.0001 | 0.0469 | 0.0012 | <0.0001 | |
RR (mmHg) | |||||||
uncontrolled* | 1.9 (0.014) | 2.0 (0.018) | 1.7 (0.017) | 1.8 (0.043) | 2.1 (0.050) | 1.9 (0.028) | <0.0001 |
controlled** | 1.7 (0.011) | 1.7 (0.033) | 1.6 (0.027) | 1.7 (0.050) | 1.7 (0.115) | 1.8 (0.037) | 0.0024 |
| <0.0001 | <0.0001 | <0.0001 | 0.4255 | 0.0025 | 0.0081 |
*SBP/DBP ≥140/90 in non-diabetic and ≥130/80 in diabetic patients, **<140/90 in non-diabetic and <130/80 in diabetic patients.
The mean CRP was higher in patients with SBP ≥180 versus <120 mmHg (1.1 versus 0.7 mmol/L), in patients with DBP ≥110 versus <90 mmHg (1.0 versus 0.8 mmol/L), and in patients with uncontrolled versus controlled blood pressure (1.0 versus 0.8 mmol/L) (
Blood pressure and CRP (mg/dL ± SD, adjusted for age, and gender).
Total | Northern Europe | Southern Europe | North America | Middle East | Asia | ||
SBP (mmHg) | |||||||
<120 | 0.7 (0.090) | 0.8 (0.131) | 0.8 (0.160) | 0.6 (0.284) | 0.6 (0.576) | 0.1 (0.304) | 0.3399 |
120–139 | 0.7 (0.037) | 0.7 (0.062) | 0.8 (0.053) | 0.4 (0.154) | 0.4 (0.286) | 0.4 (0.139) | 0.0141 |
140–159 | 0.9 (0.030) | 1.0 (0.043) | 0.9 (0.050) | 0.5 (0.146) | 1.1 (0.145) | 0.5 (0.133) | 0.0009 |
160–179 | 1.1 (0.041) | 1.1 (0.055) | 1.1 (0.070) | 0.5 (0.250) | 0.9 (0.168) | 0.6 (0.219) | 0.0196 |
≥180 | 1.1 (0.066) | 1.3 (0.087) | 0.8 (0.117) | 1.1 (0.301) | 0.8 (0.230) | 0.3 (0.500) | 0.0097 |
| <0.0001 | <0.0001 | 0.0520 | 0.0356 | 0.4130 | 0.3783 | |
DBP (mmHg) | |||||||
<90 | 0.8 (0.027) | 0.8 (0.038) | 0.8 (0.043) | 0.4 (0.112) | 0.9 (0.164) | 0.4 (0.114) | <0.0001 |
90–99 | 1.0 (0.035) | 1.1 (0.049) | 0.9 (0.058) | 0.6 (0.187) | 1.1 (0.150) | 0.6 (0.155) | 0.0022 |
100–109 | 1.1 (0.050) | 1.3 (0.072) | 1.0 (0.078) | 1.0 (0.293) | 0.8 (0.193) | 0.4 (0.253) | 0.0013 |
≥110 | 1.0 (0.091) | 1.2 (0.130) | 0.8 (0.158) | 0.6 (0.424) | 0.9 (0.338) | 0.9 (0.456) | 0.3130 |
| <0.0001 | <0.0001 | 0.4665 | 0.0056 | 0.5488 | 0.1511 | |
RR (mmHg) | |||||||
uncontrolled* | 1.0 (0.028) | 1.1 (0.031) | 0.9 (0.037) | 0.6 (0.114) | 0.9 (0.096) | 0.5 (0.106) | <0.0001 |
controlled** | 0.8 (0.026) | 0.7 (0.061) | 0.8 (0.054) | 0.4 (0.143) | 0.6 (0.348) | 0.4 (0.140) | 0.0057 |
| <0.0001 | <0.0001 | 0.1596 | 0.2786 | 0.4071 | 0.1582 |
*SBP/DBP ≥140/90 in non-diabetic and ≥130/80 in diabetic patients, **<140/90 in non-diabetic and <130/80 in diabetic patients.
In the present analysis of a large international study of patients treated for arterial hypertension, both an elevated SBP and DBP, and uncontrolled hypertension were associated with increasing BMI, WC, LDL-cholesterol, triglycerides, HbA1c, and CRP, whereas there was no association between HDL-cholesterol and blood pressure levels. Furthermore, the presence of diabetes was associated with an elevated SBP only. The observed associations between blood pressure levels and metabolic parameters were consistent across all 5 geographic regions, even though some associations were not significant, especially in regions with a low sample size for individual parameters, such as the Middle East, Asia, and—partly—North America. Based on the data presented herein, it appears difficult to draw any firm conclusions on stronger and weaker associations of individual cardiometabolic parameters with blood pressure for some regions as compared to the overall population or the European region. Furthermore, regional samples cannot be necessarily considered as ethnically/culturally homogenous and any regional analysis might be confounded by differences in the genetics or dietary habits of study participants.
Overall, our data are consistent with findings from other investigations, where the prevalence of additional cardiometabolic risk factors among hypertensive patients was as high as 82% and was associated with poor blood control in the United States [
Our results confirm the significant association between systemic hypertension and other cardiometabolic risk factors, including visceral obesity, diabetes, and hyperlipidemia. Obviously, the vast majority of patients with arterial hypertension are at multiple risk of cardiovascular disease. Therefore, our data emphasize the statement of current joint guidelines of the European Society of Hypertension and European Society of Cardiology concerning an intensified diagnostic and therapeutic measures in patients with an elevated SBP and DBP [
Reasons for the observed association between increasing blood pressure and the presence of cardiometabolic risk factors remain to be determined. It is a subject of an ongoing debate, whether patients with an elevated SBP and DBP simply more frequently have an unfavorable cardiometabolic risk profile with poorly treated cardiovascular parameters or whether there is a causal relationship between a high systemic blood pressure and the deterioration of multiple cardiometabolic markers. The intra-abdominal obesity and recently discovered endogenous gland activity of adipose tissue producing various hormones and cytokines, such as angiotensinogen, insulin, resistin, lipoprotein lipase, leptin, lactate, plasminogen activator inhibitor, adipsin, and interleukin, seem to play a central role in the development of disadvantageous cardiometabolic profile and may represent the causal link between arterial hypertension, atherogenic dyslipidemia, diabetes, thrombosis, and inflammation [
Proinflammatory mechanisms are thought to be a hallmark of the cardiovascular disease process, notably in disease states such as hypertension. These findings are often exacerbated by the increasing prevalence of obesity worldwide. Obesity is often accompanied by high plasma levels of nonesterified fatty acids that cause insulin resistance in skeletal muscle and overload the liver with lipids, producing fatty liver and atherogenic dyslipidemia [
Lifestyle changes, including an increased prevalence of obesity and the metabolic syndrome contribute to the incidence of hypertension [
The strengths of our study include the prospective enrollment of a large sample of treated hypertensive patients and the collection of detailed information on systemic blood pressure and cardiometabolic parameters.
One study limitation is the fact that the numbers of enrolled patients differ substantially between the 5 regions. Therefore, the regional comparisons and
An elevated SBP and DBP, but also uncontrolled hypertension, are associated with an increase in cardiometabolic risk, independently of the geographic region. These findings not only highlight the importance of a thorough risk-stratification of patients with arterial hypertension, but also the necessity of treating concomitant cardiometabolic risk factors in order to decrease the overall cardiovascular risk of patients with arterial hypertension.