Blood pressure is insufficiently controlled in European patients with established coronary heart disease Eric Boersma a , Ulrich Keil b , Dirk De Bacquer c , Guy De Backer c , Kalevi Pyo¨ ra¨la¨ d , Don Poldermans a , Cristiana Leprotti e , Lorenza Pilotto f , Esther de Swart a , Jaap W. Deckers a , Jan Heidrich b , Susana Sans g , Kornelia Kotseva h , David Wood h and Giovanni B. Ambrosio e , for the EUROASPIRE I and II Study Groups Background Elevated blood pressure is associated with an impaired prognosis in patients with established coronary heart disease. Adequate blood pressure control is therefore of utmost importance. We report on two successive European surveys that evaluated whether the goals given in recommendations on secondary prevention are achieved. Methods The first European Action on Secondary Prevention through Intervention to Reduce Events (EUROASPIRE I) survey was conducted during 1995–1996 in 21 hospitals in nine European countries. The second survey (EUROASPIRE II) was conducted during 1999– 2000 in 47 hospitals (including 20 hospitals that participated in EUROASPIRE I) in 15 Europeans countries. Consecutive patients (aged < 71 years) were identified from hospital records after coronary artery bypass grafting, percutaneous coronary intervention, myocardial infarction, or myocardial ischaemia. Patients were invited for an interview and examination at least 6 months after hospitalization. During the interview, blood pressure was measured in a standardized fashion. Systolic blood pressure > 140 mmHg and/or a diastolic blood pressure > 90 mmHg were considered as elevated blood pressure. EUROASPIRE II provides a more comprehensive view on the actual management of patients with established coronary disease. Therefore, we decided to concentrate mainly on the EUROASPIRE II data, and to use EUROASPIRE I for the evaluation of time trends. Results In EUROASPIRE II, 5556 patients were interviewed, and 51% were diagnosed with elevated blood pressure. Large regional variations in the prevalence of elevated blood pressure were observed, with values ranging from 37 to 64%. Twenty-five per cent (1401) of patients were on a diet to reduce blood pressure, and among these 61% had elevated blood pressure. The prevalence of elevated blood pressure among the 4827 (87%) patients taking blood pressure-lowering medication (which was not necessarily taken as an antihypertensive treatment) was 51%. Patients with elevated blood pressure were more likely to be diabetic, hypercholesterolemic, and obese than normotensive patients. The proportion of patients who reported being aware of their hypertensive status was somewhat higher in EUROASPIRE II than in EUROASPIRE I (71 versus 67%), and the use of blood pressure-lowering medication was intensified (91 versus 85%). However, these changes were not accompanied by a decrease in the prevalence of elevated blood pressure (54 versus 55% in centres that participated in both surveys). Conclusion During 1995–2000 the prevalence of elevated blood pressure in patients with established coronary heart disease remained at an unacceptably high level. Throughout Europe, still about half of coronary patients require more intensive blood pressure management. J Hypertens 21:1831–1840 & 2003 Lippincott Williams & Wilkins. Journal of Hypertension 2003, 21:1831–1840 a Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands, b Institute of Epidemiology and Social Medicine, University of Mu¨ nster, Mu¨ nster, Germany, c Department of Public Health, Ghent University, Ghent, Belgium, d Department of Medicine, University of Kuopio, Kuopio, Finland, e CNR Unit for Muscle Pathophysiology, University of Padua, Padua, Italy, f Center for Cardiovascular Diseases, Department of Cardiology, S M Misericordia Hospital, Udine, Italy, g Institute of Health Studies, Department of Health and Social Security, Barcelona, Spain and h Department of Clinical Epidemiology, National Heart and Lung Institute, London, UK. Sponsorship: Unrestricted educational grants to the European Society of Cardiology were obtained from Merck, Sharp and Dohme for EUROASPIRE I, and from Astra Zeneca; Bristol-Myers Squibb; Merck, Sharp and Dohme; and Pfizer for EUROASPIRE II. Correspondence and requests for reprints to Eric Boersma, Erasmus Medical Center Thoraxcenter Cardiology, room H543, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands. Tel: +31 (0)10 4633909; fax: +31 (0)10 4089484; e-mail: h.boersma@erasmusmc.nl Received 24 March 2003 Revised 5 June 2003 Accepted 6 June 2003 Introduction Elevated blood pressure is associated with an increased risk of cardiovascular disease, stroke and renal failure in the general population, whereas reduction of elevated blood pressure is associated with improved outcome [1–3]. Adequate blood pressure control is therefore of Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. Original article 1831 0263-6352 & 2003 Lippincott Williams & Wilkins DOI: 10.1097/01.hjh.0000084771.37215.89