Control of arterial hypertension in Spain: a systematic review and meta-analysis of 76 epidemiological studies on 341 632 participants.

OBJECTIVE: Hypertension is a leading global risk factor for the burden of cardiovascular disease. Data about changes in hypertension control are important to set intervention priorities. We conducted a systematic review and meta-analysis of epidemiological studies to determine the control of hypertension in Spain over the past decade.
METHODS: A search of PubMed/MEDLINE, SCOPUS and IME was performed for epidemiological studies conducted in Spain (since 2000) with data on control rates for hypertension. The primary outcome was the prevalence of uncontrolled hypertension defined as the percentage of patients having SBP at least 140 mmHg and/or DBP at least 90 mmHg. For populations at risk (e.g. patients with diabetes), the definition was SBP at least 130 mmHg and/or DBP at least 80-85 mmHg.
RESULTS: Seventy-six studies evaluating 341 632 patients (79% with hypertension) met the inclusion criteria. Among hypertensive patients, the overall pooled prevalence of uncontrolled hypertension (≥140/90 mmHg) was 67.0% [95% confidence interval (CI) 64.1-69.9%], but was 87.6% (95% CI 86.2-89.0%) when the most restricted definition (≥130/80-85 mmHg) was used for patients at risk. The test for heterogeneity was significant (P < 0.001). Using metaregression analyses, we showed that the prevalence of uncontrolled hypertension did not change significantly over time, but the percentage of patients receiving at least two antihypertensive drugs increased (P = 0.032 and 0.001).
CONCLUSION: In Spain, the control of hypertension is far from optimum and does not appear to have improved in recent years despite the increased intensity of therapy. Patients at risk with comorbidities appear to be controlled worse.