Association of education and feedback on hypertension management with risk for stroke and cardiovascular disease

Figures & data

Table 1. Characteristics of participants at the time of inclusion, stratified by county.

	County
Variable	Västerbotten (Intervention)	Södermanland (Control)
Participants (inclusions in cohorts), No.	578,132	679,086
Unique individuals, No.	121,365	131,924
Median No. cohorts per unique individual	2	3
Sex, No (%)
Female	346,158 (59.9)	415,335 (61.2)
Male	231,974 (40.1)	263,751 (38.8)
Age in year
Mean (SD)	61.7 (16.3)	63.6 (16.2)
Age group, No (%)
18–64	298,585 (51.7)	315,477 (46.5)
65–79	204,731 (35.4)	252,575 (37.2)
≥ 80	74,816 (12.9)	111,034 (16.4)
Blood pressure in mm Hg
Mean SBP (SD)	142.3 (20.6)	144.1 (21.4)
Mean DBP (SD)	82.6 (11.1)	81.1 (10.7)
Blood pressure categories, No (%)
< 120	55,407 (9.6)	56,542 (8.3)
120–129	82,067 (14.2)	86,063 (12.7)
130–139	108,167 (18.7)	109,492 (16.1)
140–149	123,049 (21.3)	147,631 (21.7)
150–159	81,600 (14.1)	100,741 (14.8)
160–169	62,856 (10.9)	85,340 (12.6)
170–179	30,988 (5.4)	42,094 (6.2)
≥ 180	33,998 (6.0)	51,183 (7.5)
Co-morbidities, No (%)
Hypertension	305,663 (52.9)	329,117 (48.5)
Diabetes	83,262 (14.4)	119,957 (17.7)
Coronary artery disease	755 (0.1)	2,170 (0.3)
Atrial fibrillation	13,655 (2.4)	16,914 (2.5)
Yearly disposable income by quintiles, No (%)*
< 90 000	111,969 (19.4)	139,475 (20.5)
90 000 to 108 000	113,074 (19,6)	138,366 (20.4)
108 000 to 132 000	116,423 (20.1)	135,014 (19.9)
132 000 to 171 000	120,650 (20.9)	130,786 (19.3)
>171 000	116,011 (20.1)	135,428 (19.9)
Civil status, No (%)**
Unmarried	119,521 (20.7)	104,856 (15.5)
Married	300,512 (52.0)	362,417 (53.4)
Divorced	65,955 (11.4)	95,175 (14.0)
Widowed	91,943 (15.9)	116,381 (17.1)
Educational level, No (%)***
Elementary school	125,376 (27.9)	181,770 (36.5)
Secondary school	217,093 (48.2)	222,692 (44.7
University degree	107,580 (23.9)	93,899 (18.8)

*Total income minus taxes and transfers, adjusted for household composition. Numbers are in SEK (1 SEK = 0.11 USD = 0.095 EUR on 3rd January 2020). Twenty-two participants (0.00%) with missing data. ** 480 participants (0.04%) with missing data. ***308 808 participants (24.6%) with missing data. Only available for participants younger than 75 years.

Table 2. Hazard ratios for primary and secondary cardiovascular outcomes.

	Individuals with events, No.		Participants with events, No.		Unadjusted hazard ratio (95 % CI)	Adjusted hazard ratio (95 % CI)
	Intervention	Control	Intervention	Control
Primary outcome
Stroke	2,823	3,584	8,539	11,538	0.84 (0.79 to 0.90)	0.96 (0.90 to 1.03)
Secondary outcomes
Myocardial infarction	2,467	2,988	7,124	8,731	0.93 (0.86 to 0.995)	1.04 (0.97 to 1.12)
MACE	5,164	6,406	15,317	19,795	0.90 (0.86 to 0.94)	1.02 (0.97 to 1.07)
Heart failure	1,453	1,949	4,451	6,215	0.83 (0.76 to 0.91)	0.98 (0.89 to 1.07)
All-cause mortality	7,034	10,040	17,982	26,289	0.80 (0.77 to 0.83)	0.91 (0.87 to 0.95)
Cardiovascular Mortality	2,472	3,743	6,784	10,095	0.78 (0.73 to 0.84)	0.91 (0.85 to 0.98)

MACE – Major adverse cardiovascular event. CI – confidence interval. Note: Stroke, myocardial infarction, MACE and heart failure include data only from the National Patient Register. All-cause and cardiovascular mortality include data from the National Patient Register and the Cause of Death Register. Covariates for adjusted hazard ratios were age, sex, hypertension, diabetes mellitus, coronary artery disease, atrial fibrillation, systolic blood pressure at inclusion, marital status, and disposable income.

Table 3. hazard ratios for primary and secondary outcomes by year of inclusion.

	2001	2002	2003	2004	2005	2006	2007	2008	2009
Unadjusted hazard ratios (95% CI)
Stroke	0.90 (0.78 to 1.05)	0.85 (0.73 to 0.99)	0.77 (0.66 to 0.90)	0.84 (0.73 to 0.98	0.82 (0.71 to 0.94)	0.90 (0.78 to 1.04)	0.78 (0.67 to 0.90)	0.85 (0.73 to 0.98)	0.93 (0.80 to 1.09)
Myocardial infarction	0.99 (0.85 to 1.16)	1.02 (0.87 to 1.19)	1.00 (0.85 to 1.18)	0.89 (0.75 to 1.06)	0.95 (0.80 to 1.12)	0.88 (0.75 to 1.03)	0.83 (0.71 to 0.98)	0.93 (0.79 to 1.10)	0.97 (0.81 to 1.14)
MACE	0.94 (0.84 to 1.04)	0.92 (0.82 to 1.02)	0.87 (0.78 to 0.98)	0.88 (0.79 to 0.98)	0.87 (0.78 to 0.97)	0.92 (0.84 to 1.02)	0.85 (0.77 to 0.95)	0.95 (0.85 to 1.06)	1.00 (0.89 to 1.11)
Heart failure	0.97 (0.79 to 1.20)	0.93 (0.75 to 1.15)	0.75 (0.61 to 0.92)	0.73 (0.59 to 0.90)	0.81 (0.61 to 0.99)	0.87 (0.71 to 1.05)	0.83 (0.68 to 1.01)	0.80 (0.66 to 0.96)	0.85 (0.70 to 1.04)
All-cause mortality	0.80 (0.73 to 0.88)	0.75 (0.68 to 0.83)	0.79 (0.71 to 0.87)	0.77 (0.69 to 0.85)	0.80 (0.73 to 0.88)	0.83 (0.76 to 0.91)	0.78 (0.72 to 0.86)	0.84 (0.77 to 0.91)	0.82 (0.75 to 0.89)
Cardiovascular mortality	0.87 (0.75 to 1.00)	0.71 (0.61 to 0.84)	0.76 (0.65 to 0.89)	0.82 (0.69 to 0.97)	0.82 (0.70 to 0.96)	0.84 (0.72 to 0.98)	0.82 (0.71 to 0.95)	0.76 (0.65 to 0.88)	0.73 (0.62 to 0.84)
Adjusted hazard ratios (95% CI)
Stroke	1.02 (0.88 to 1.18)	0.96 (0.82 to 1.12)	0.87 (0.74 to 1.01)	0.95 (0.82 to 1.11)	0.92 (0.80 to 1.07)	1.01 (0.88 to 1.16)	0.90 (0.77 to 1.04)	0.98 (0.84 to 1.14)	1.07 (0.92 to 1.25)
Myocardial infarction	1.11 (0.95 to 1.30)	1.14 (0.97 to 1.33)	1.11 (0.94 to 1.30)	1.00 (0.84 to 1.18)	1.07 (0.91 to 1.26)	0.95 (0.81 to 1.11)	0.92 (0.78 to 1.08)	1.05 (0.90 to 1.24)	1.10 (0.92 to 1.31)
MACE	1.05 (0.95 to 1.17)	1.03 (0.92 to 1.15)	0.98 (0.88 to 1.09)	0.98 (0.88 to 1.10)	0.98 (0.88 to 1.09)	1.01 (0.92 to 1.12)	0.96 (0.87 to 1.07)	1.08 (0.97 to 1.20)	1.14 (1.02 to 1.27)
Heart failure	1.17 (0.95 to 1.45)	1.12 (0.90 to 1.39)	0.93 (0.75 to 1.14)	0.90 (0.73 to 1.11)	0.94 (0.77 to 1.16)	0.95 (0.78 to 1.16)	0.94 (0.77 to 1.16)	0.94 (0.77 to 1.14)	0.99 (0.81 to 1.21)
All-cause mortality	0.93 (0.84 to 1.02)	0.88 (0.79 to 0.97)	0.91 (0.82 to 1.00)	0.89 (0.80 to 0.99)	0.91 (0.83 to 1.00)	0.90 (0.83 to 0.99)	0.87 (0.80 to 0.95)	0.95 (0.87 to 1.04)	0.92 (0.84 to 1.00)
Cardiovascular Mortality	1.02 (0.88 to 1.19)	0.84 (0.71 to 0.99)	0.90 (0.76 to 1.06)	0.97 (0.82 to 1.15)	0.93 (0.80 to 1.09)	0.93 (0.79 to 1.08)	0.92 (0.79 to 1.07)	0.87 (0.75 to 1.01)	0.82 (0.71 to 0.96)

MACE – major adverse cardiovascular event. Stroke, myocardial infarction, MACE and heart failure include data only from the National Patient Register. All-cause and cardiovascular mortality include data from the National Patient Register and the Cause of Death Register. Covariates for adjusted hazard ratios were age, sex, hypertension, diabetes mellitus, coronary artery disease, atrial fibrillation, systolic blood pressure at inclusion, marital status, and disposable income.

Data availability statement

According to Swedish law, the data underlying this study cannot be shared with a third party. Metadata may be shared available from the corresponding author (MB) upon reasonable request.