Control de la presión arterial y del riesgo cardiovascular en la población rural y urbana de España

Resum

Prevalence and control of hypertension seem to be influenced by population, geographical and psychosocial factors. Aims To investigate if the places of residence (rural or urban) determine differences in both BP level (office and 24-hour ambulatory BP monitoring (ABPM)) and cardiovascular risk (CVR). We also assess if place of residence establishes differences regarding treatment of the cardiovascular risk patients. Methods Data of 25,989 patients from the ABPM National Registry of the Spanish Society of Hypertension were analyzed. Out of them 80.8% (n = 20,998) were from urban settings and 19.2% (n = 4991) from rural settings. Date from subjects less than 65 years of age were analyzed in order to diminish the influence of residence changes following retirement. We measured office BP, 24 h ABPM, cardiovascular risk factors and CVR. Results The percentage of patients with BP <140/90 mmHg in the office is higher in the urban group (23.4%) compared to their rural counterparts (21.4%) (p = 0.003). This fact lost its statistical significance when BP was measured by ABPM, showing controlled 46.1% in urban and 45.9% in rural settings. The masked hypertension was higher in urban (7.2%) than in rural settings (6.4%). White coat hypertension was more frequent in rural settings (31.6% versus 29.7%, p < 0.008). According to estimates of ESH-ESC 2007 guidelines, patients from the rural setting have a higher CVR. Conclusions There are no differences in the hypertension control depending on place of residence when this is measured by ABPM. CVR is worse in the rural environment. This fact is linked to a higher level of obesity and its associated metabolic disorders.