Quality of care for hypertension in the United States

Asch, Steven M.; McGlynn, Elizabeth A.; Hiatt, Liisa; Adams, John; Hicks, Jennifer; DeCristofaro, Alison H.; Chen, Roland; Lapuerta, Pablo; Kerr, Eve A.

doi:10.1186/1471-2261-5-1

Cited by 73 publications

(60 citation statements)

References 22 publications

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“…Although our analyses do not directly demonstrate that therapy modifications led to better control, their validity is indirectly supported by the several randomized, controlled trials that have demonstrated the efficacy of these pharmacotherapeutic interventions (1)(2)(3)(4)(5). Several previous studies have also shown that clinical inertia was associated with poor risk factor control (12,39) and intensification of therapy with better control (17,(39)(40)(41). A final validation would examine whether higher rates of treatment intensification or "appropriate care" are associated with better levels of control across populations or over time.…”

Section: Discussionmentioning

confidence: 97%

“…Such measures have been proposed to have several advantages over simpler process measures, such as rates of risk factor testing, and also over levels of control. Intensification of therapy, but not higher testing rates for risk factors (7,19), has been shown to lead to better control (17,(39)(40)(41). For example, a study in 30 U.S. academic medical centers found a very high proportion of testing rates (88% to 97%) for cardiovascular risk factors in patients with diabetes, but a low proportion of patients in control (33% to 46%) and a low rate of therapy modifications in those with elevated risk factor levels (14% to 46%) (19).…”

Section: Discussionmentioning

confidence: 99%

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Therapy Modifications in Response to Poorly Controlled Hypertension, Dyslipidemia, and Diabetes Mellitus

et al. 2006

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Therapy Modifications in Response to Poorly Controlled Hypertension, Dyslipidemia, and Diabetes Mellitus

et al. 2006

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“…Our findings are supported by several studies that have separately investigated concordant and discordant patient comorbidities. Some have reported the positive impact of separate concordant comorbidities on the management of cardiovascular risk factors, 23,24 whereas others have found negative impacts of individual discordant comorbidities on management of these risk factors. [25][26][27] We believe this is the first study to examine the concurrent, separate, and linear contributions of concordant and discordant comorbidities on management of a single cardiovascular risk factor.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Concordant and Discordant Conditions on the Quality of Care for Hyperlipidemia

et al. 2008

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BACKGROUND: Physician treatment of cardiovascular risk factors may be affected by specific types of patient comorbidities.OBJECTIVES: To examine the relationship between discordant comorbidities and LDL-cholesterol management in hypertensive patients not previously treated with lipid-lowering therapy; to determine whether the presence of cardiovascular (concordant) conditions mediates this relationship. DESIGN:We performed a retrospective cohort study of 1,935 hypertensive primary care patients (men >45 years of age, women >55 years of age) with documented elevated low-density lipoprotein (LDL) cholesterol and no lipid-lowering therapy at baseline. The outcome was guideline-consistent hyperlipidemia management defined as optimal value on repeat LDL cholesterol testing or initiation of lipid-lowering therapy. Using generalized estimating equations (GEE), we examined the association of concordant and discordant comorbidities with guideline-consistent hyperlipidemia management over a 2-year follow-up period, adjusting for patient characteristics.RESULTS: Guideline-consistent hyperlipidemia management was achieved in 1,236 patients (64%). In the fully adjusted model, each additional discordant condition resulted in a 19% lower adjusted odds ratio of guideline-consistent hyperlipidemia management (p< 0.001) when compared with no discordant conditions. The dampening effect of discordant conditions on guideline-consistent management persisted even in the presence of concordant conditions, but each additional concordant condition was associated with a 37% increase in the adjusted odds of guideline-consistent hyperlipidemia management (p<0.001).CONCLUSIONS: In this cohort of hypertensive primary care patients, the number of conditions discordant with cardiovascular risk was strongly negatively associated with guideline-consistent hyperlipidemia management even in patients at the highest risk for cardiovascular events and cardiac death.KEY WORDS: hyperlipidemia; quality of care; comorbidity.

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“…Asch et al 24 have recently described the correlates of optimal care of patients with hypertension using explicit indicators of the care process. They observed that the following categories of hypertensive patients were more likely to receive optimal care: those Ͼ50 years of age; patients with diabetes, coronary artery disease, or hyperlipidemia; and nonsmokers.…”

Section: Quality Of Hypertension Care: Impact Of Select Patient-relatmentioning

confidence: 99%

Epidemiology of Uncontrolled Hypertension in the United States

2005

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H ypertension is a powerful risk factor for fatal and nonfatal cardiovascular disease events. Data from observational studies indicate that this risk is continuous, without evidence of a threshold, down to blood pressures as low as 115/75 mm Hg. 1 Randomized controlled trials have convincingly shown that treatment of hypertension reduces the risk of stroke, coronary heart disease, congestive heart failure, and mortality. 2,3 Because hypertension currently affects 1 in 4 American adults (Ϸ65 million people in 1999 to 2000) 4 and may affect Ͼ90% of individuals during their lifetimes, 5 adequate control of blood pressure is of enormous public health importance. However, recent studies indicate that as many as two thirds of those with hypertension in the United States are either untreated or undertreated. 6 Studies based on national data and community cohorts have shed light on the reasons underlying this poor control, but several questions remain unanswered. In this article, we review contemporary data on the epidemiology of uncontrolled hypertension in the United States by (1) defining what constitutes "controlled hypertension"; (2) describing the current magnitude of the problem, including temporal trends; (3) summarizing the public health consequences of uncontrolled hypertension; (4) examining the clinical correlates of uncontrolled hypertension and appraising the patient-and physician-related factors related to poor control of blood pressure; and (5) identifying future research directions, including potential interventions to address this problem. In this article, "uncontrolled hypertension" signifies blood pressure that is inadequately treated rather than blood pressure that is resistant to treatment, as might be observed with secondary causes of hypertension such as renal artery stenosis.

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Quality of care for hypertension in the United States

Cited by 73 publications

References 22 publications

Therapy Modifications in Response to Poorly Controlled Hypertension, Dyslipidemia, and Diabetes Mellitus

Therapy Modifications in Response to Poorly Controlled Hypertension, Dyslipidemia, and Diabetes Mellitus

The Impact of Concordant and Discordant Conditions on the Quality of Care for Hyperlipidemia

Epidemiology of Uncontrolled Hypertension in the United States

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