Uncontrolled hypertension is a major cardiovascular risk factor. We examined uncontrolled hypertension and differences in treatment regimens between a high-risk country, Russia, and low-risk Norway to gain better understanding of the underlying factors. Population-based survey data on 40–69 year olds with hypertension defined as taking antihypertensives and/or having high blood pressure (140+/90+ mmHg) were obtained from Know Your Heart Study (KYH, N = 2284), Russian Federation (2015–2018) and seventh wave of The Tromsø Study (Tromsø 7, N = 5939), Norway (2015–2016). Uncontrolled hypertension was studied in the subset taking antihypertensives (KYH: N = 1584; Tromsø 7: 2792)and defined as having high blood pressure (140+/90+ mmHg). Apparent treatment resistant hypertension (aTRH) was defined as individuals with uncontrolled hypertension on 3+ OR controlled on 4+ antihypertensive classes in the same subset. Among all those with hypertension regardless of treatment status, control of blood pressure was achieved in 22% of men (KYH and Tromsø 7), while among women it was 33% in Tromsø 7 and 43% in KYH. When the analysis was limited to those on treatment for hypertension, the percentage uncontrolled was higher in KYH (47.8%, CI 95 44.6–50.9%) than Tromsø 7 (38.2, 36.1–40.5%). The corresponding figures for aTRH were 9.8% (8.2–11.7%) and 5.7% (4.8–6.8%). Antihypertensive monotherapies were more common than combinations and used by 58% in Tromsø 7 and 44% in KYH. In both KYH and Tromsø 7, untreated hypertension was higher in men, those with no GP visit in the past year and problem drinkers. In both studies, aTRH was associated with older age, CVD history, obesity, and diabetes. In Tromsø 7, also male gender and any drinking. In KYH, also chronic kidney disease. There is considerable scope for promoting combination therapies in line with European treatment guidelines in both study populations. The factors associated with untreated hypertension overlap with known correlates of treatment non-adherence and health check non-attendance. In contrast, aTRH was characterised by obesity and underlying comorbidities potentially complicating treatment.

中文翻译：

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不受控制和明显难治性高血压：针对俄罗斯和挪威 40-69 岁人群的横断面研究


不受控制的高血压是主要的心血管危险因素。我们检查了未受控制的高血压以及高风险国家俄罗斯和低风险挪威之间治疗方案的差异，以更好地了解潜在因素。基于人群的 40-69 岁高血压患者的调查数据（定义为服用抗高血压药物和/或患有高血压 (140+/90+ mmHg)）来自俄罗斯联邦的“了解你的心脏研究”（KYH，N = 2284）（ 2015-2018）和第七波特罗姆瑟研究（特罗姆瑟 7，N = 5939），挪威（2015-2016）。在服用抗高血压药物的子集中研究了未受控制的高血压（KYH：N = 1584；Tromsø 7：2792），并将其定义为高血压（140+/90+ mmHg）。表观难治性高血压 (aTRH) 被定义为同一亚组中使用 3+ 抗高血压药物治疗未受控制的高血压或使用 4+ 抗高血压药物治疗得到控制的个体。在所有高血压患者中，无论治疗状况如何，22% 的男性（KYH 和 Tromsø 7）实现了血压控制，而女性中，Tromsø 7 的这一比例为 33%，KYH 为 43%。当分析仅限于接受高血压治疗的患者时，KYH 的未控制百分比（47.8%，CI 95 44.6–50.9%）高于 Tromsø 7（38.2，36.1–40.5%）。 aTRH 的相应数字为 9.8% (8.2–11.7%) 和 5.7% (4.8–6.8%)。抗高血压单一疗法比联合疗法更常见，Tromsø 7 的使用率为 58%，KYH 的使用率为 44%。在 KYH 和 Tromsø 7 中，未经治疗的高血压在男性、过去一年没有去看全科医生的人和有问题的饮酒者中较高。在这两项研究中，aTRH 与年龄较大、CVD 病史、肥胖和糖尿病有关。在特罗姆瑟 7，也包括男性和任何饮酒行为。在 KYH 中，还有慢性肾脏疾病。 在这两个研究人群中，根据欧洲治疗指南，推广联合疗法的空间很大。与未经治疗的高血压相关的因素与不遵守治疗和不参加健康检查的已知相关因素重叠。相比之下，aTRH 的特点是肥胖和潜在的合并症，可能使治疗复杂化。