Detection, treatment, and control of adult hypertension in Northwest Indiana

Abstract

Recent data from the third National Health and Nutrition Examination Survey (NHANES-IIIB) suggest that detection and treatment of hypertension is improving, but only 27.4% of American hypertensives achieved controlled blood pressure ([BP] < 140 and < 90 mm Hg). Our objective was to assess the degree of BP control in a group of steelworkers and their families whose health care is financed by a large corporation. A random sample of 792 adults (age > 18 years, average 55 +/- 1 years, 50.4% male) was selected from a roster of patients who were known (from claims data) to have visited a physician in 1995 to 1996. Office charts were reviewed by trained nurses, who abstracted dates of 4095 visits, 3352 BP readings, and 3331 prescribed medications. Filled prescriptions were identified from 54,689 claims submitted for pharmacy services. Hypertension, defined (per NHANES) as more than one BP reading of 140/90 or higher, or taking antihypertensive medication, was found in 437 (55%). At least one antihypertensive medication was prescribed for 386 (88%) of the hypertensives; only 10 failed to have any prescription for antihypertensive medications filled. Controlled hypertension, as defined by Healthcare Employer Data Information Sheet (HEDIS) 3.0 (average BP < 140 and < 90 mm Hg in the office during a year-long period of observation), was observed in 189 patients (43% of total sample, or 50% of the 382 with at least one recorded BP measurement). These data suggest that in this population, insured by a jointly run employer-union health benefits plan, Healthy People 2000's BP goal-at least 50% of hypertensives having BP under control by the turn of the century-may be achieved ahead of schedule.

Assessment of Factors Influencing Blood Pressure Control in a Managed Care Population

“…The fact that 74% of our patients met HEDIS criteria for blood pressure control was unexpected based on published studies indicating control rates of up to 45%. 3,13,18,19 In 2001, 55.4% of people aged 46-85 years in HEDIS-participating commercial managed care plans achieved adequate blood pressure control. 13 Although our patient population may have differed from those examined in previous studies, our results clearly indicate that blood pressure control in our primary care clinics exceeds the reported national average.…”

“…This is supported by studies indicating that both high drug costs and low levels of health insurance correlate with poorer blood pressure control. 6,[18][19][20][21][22] In addition, patients analyzed in this study had two or more physician visits during the year. Hence, physicians may have been more likely to monitor them closely and manage their blood pressures aggressively, resulting in better disease control.…”

“…19 Similarly, only 15% of diabetics in another study achieved that goal. 18 Given the documented benefits (cardiovascular, cerebrovascular, renal) of reducing blood pressure in diabetic patients, the findings of these studies point to the need for more aggressive and appropriate blood pressure management in these high-risk individuals.…”

Current Perspectives on the Role of Captopril Imaging in the Diagnosis of Renovascular Disease

“…3 Hypertension is defined as a systolic blood pressure > 140 mmHg or a diastolic blood pressure > 90 mmHg taken on more than one occasion. 4 Of the surgically correctable causes of hypertension, a renovascular etiology is the most common but is found in only a small percentage (3 to 5%) of the total hypertensive population. 5 While some degree of renal artery narrowing can be identified in many patients with atherosclerosis, not all renal artery stenoses are hemodynamically and clinically significant.…”

Development of a Parametric Simulation Model for Forecasting Goal-Oriented Treatment Outcomes

“…Treatment guidelines for chronic diseases are often subject to revision as newer and more reliable disease-specific data become available [1][2][3]. The use of quality indicators to measure and evaluate health-care delivery has led to a rapid growth in the number of treatment-to-goal (TTG) analyses [4][5][6][7][8][9]. Decision makers in managed care are increasingly interested in assessing a drug's potential ability to achieve predefined treatment goals before rendering formulary or reimbursement decisions.…”