Hypertension Management and Control in Primary Care: A Study of 20 Practices in 14 States

Abstract

Study Objective. To describe the management and control of hypertension in primary care practice. Design. Retrospective medical record review. Setting. Twenty primary care practices in 14 states. Patients. Thirteen thousand forty-seven patients with hypertension. Measurements and Main Results. Diagnoses, drugs prescribed, and blood pressure readings were extracted from the electronic medical record at each practice in the study. For patients with hypertension and comorbid diagnoses, the most recent blood pressure and antihypertensive drugs prescribed were determined. Analyses assessed the blood pressure control rates and the association between control and demographic variables, frequency of visits to the practice site, and pharmacologic treatment patterns. Among the 20 practices in the study, 13,047 patients had received a diagnosis of hypertension and their blood pressures had been measured within the previous 12 months. One third of the patients had comorbid coronary heart disease, diabetes mellitus, heart failure, and/or renal insufficiency. The most recent blood pressure reading was below 140/90 in half the patients. Control was associated with age 60 years or younger, female sex, more than one visit to the practice, more than one comorbidity, and type of practice (p<0.01, logistic regression). Wide variability was noted among practices in the use of multiagent antihypertensive therapy, and in antihypertensive therapy by drug class. Among patients without comorbidity treated with one drug, systolic blood pressure did not differ significantly by drug class. Diastolic blood pressure was slightly lower in patients prescribed thiazide diuretics than in those prescribed angiotensin receptor blockers (p=0.03, analysis of covariance). Conclusion. Blood pressure control in primary care practice can be much better than reports usually indicate. Good control in this study was not due to specific drug choice, but instead may have been due to regular monitoring of blood pressure and motivation of the practice to improve patient care.

Treatment and control of hypertension in Turkish population: a survey on high blood pressure in primary care (the TURKSAHA study)

“…11 However, among the hypertensives receiving treatment in general practice in Poland, the blood pressure control rate is lower than 10% according to the control level of 140/90 mm Hg. 12 Although varying figures are presented for the blood pressure control rate among hypertensive patients receiving treatment in primary care services in USA, [13][14] overall they are higher than those reported for European countries. Maue et al 13 have reported BP control rate according to the level of 140/90 mm Hg to be 41% (36% according to the 130/85 level for diabetics) in USA primary care services, compared with the approximate 50% reported by Ornstein et al…”

Medication Adherence in a Sample of Elderly Suffering from Hypertension: Evaluating the Influence of Illness Perceptions, Treatment Beliefs, and Illness Burden

“…6,7 However, studies evaluating data from those with hypertension-obtained from various sources such as national survey data, epidemiologic studies, ambulatory care practices, and high-risk patients-report a varying rate of hypertension control ranging from 29% to 50%. 4,[8][9][10][11][12][13][14][15][16][17] Medication nonadherence is cited as the primary cause for lack of hypertension control. 5,18 Medication nonadherence is defined as the failure to adhere to medication instructions, either willfully or inadvertently.…”

Epidemiology of Uncontrolled Hypertension in the United States

“…In NHANES and most epidemiological studies, the definition of hypertension is based on the blood pressure recorded at the study examination and the use of antihypertensive medications. Failure to account for use of nonpharmacological therapies may misclassify some individuals as nonhypertensive when they are in fact treated and controlled, 6,39 resulting in an underestimation of hypertension control rates. In contrast, several studies, including the NCQA report, rely on International Classification of Disease, ninth revision, diagnoses of hypertension or diagnoses contained in the medical record, 15,39 an approach that may inflate estimates of hypertension control for 2 reasons.…”