Primary Care Research

Hypertension control is greater in U.S. primary care practices than usually reported

More than one-fourth of adults in the United States suffer from hypertension (high blood pressure). A survey of 20 primary care practices in 14 States found that half of all patients with hypertension had controlled blood pressure at their last measurement (below 140/90 mm Hg). This is far better control than usually reported. The good control was not due to specific antihypertensive drug choice, but instead it may have been due to regular monitoring of blood pressure (via frequent visits to the doctor) and motivation of the practice to improve patient care, explains Steven Ornstein, M.D., of the Medical University of South Carolina.

In a study supported by the Agency for Healthcare Research and Quality (HS11132), Dr. Ornstein and his colleagues analyzed blood pressure control rates and the association between control and demographic variables, frequency of visits to the practice site, and medication treatment patterns among 13,047 patients with hypertension in the practices. 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 coexisting medical condition, type of practice, and more than one visit to the practice during the year. These visits probably provided a greater opportunity for doctors to affect drug dosage titration, focus attention on lifestyle modification issues, and adapt treatment regimens to patient-specific issues.

Practices varied widely in their use of multiagent antihypertensive therapy and in antihypertensive therapy by drug class. Among patients without coexisting disease who were treated with one drug, systolic blood pressure did not differ significantly by drug class. However, diastolic blood pressure was slightly lower in patients prescribed thiazide diuretics than in those prescribed angiotensin receptor blockers.

See "Hypertension management and control in primary care: A study of 20 practices in 14 states," by Dr. Ornstein, Paul J. Nietert, Ph.D., and Lori M. Dickerson, Pharm.D., F.C.C.P., in Pharmacotherapy 24(4), pp. 500-507, 2004.

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