Blood pressure control among Canadians with hypertension, with and without diabetes
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The thesis offers the following contributions to the epidemiology of hypertension in Canada: 1.The first manuscript uses cross-sectional data from the 2007-2009 Canadian Health Measures Survey (CHMS) to compare the prevalence of controlled hypertension between people with and without diabetes. Of the 74% of Canadians with diabetes who had hypertension, 56% (95% CI: 45%-66%) had controlled blood pressure compared to 64% (95% CI: 58%-69%) of Canadians without diabetes. Among people taking medication, individuals with diabetes were less likely to have controlled hypertension (ORadjusted: 0.3; 95% CI: 0.2-0.6). 2.The objective of the second manuscript was to determine, among Canadians with hypertension, whether individuals with diabetes were less likely than those without to recall health professional advice for healthy behaviours and whether receipt of such advice influences behaviour, using cross-sectional data from the 2009 Survey on Living with Chronic Diseases in Canada (SLCDC). Canadians with diabetes were more likely than those without to recall advice to control/lose weight (81% vs. 66%), exercise (79% vs. 68%), limit alcohol (78% vs. 55%) and modify diet (70% vs. 61%) but not limit salt (65% vs. 64%). Both groups were equally likely to report following advice, with receipt of advice positively associated with engagement in healthy behaviours. 3. The third manuscript describes knowledge of blood pressure targets in Canadians with hypertension using cross-sectional data from the 2009 SLCDC. Knowledge of blood pressure targets was low, with 28% and 32% of Canadians with and without diabetes reporting having discussed a blood pressure target and reporting a target in line with clinical practice guidelines. 4.The fourth manuscript validates an existing self-reported blood pressure control question in a sample of 161 patients with hypertension in Kingston. In people with and without diabetes, the question had sensitivities of 83% ± 11% and 78% ± 10% and specificities of 30% ±19% and 58% ± 21%, respectively. 5.The final manuscript tests a method designed to account for misclassification in epidemiologic studies, using data from the CHMS. The method was found to perform inconsistently in multivariate contexts and introduced bias when minor differential misclassification was ignored.