Document Detail

Inadequate management of blood pressure in a hypertensive population.
MedLine Citation:
PMID:  9869666     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Many patients with hypertension have inadequate control of their blood pressure. Improving the treatment of hypertension requires an understanding of the ways in which physicians manage this condition and a means of assessing the efficacy of this care. METHODS: We examined the care of 800 hypertensive men at five Department of Veterans Affairs sites in New England over a two-year period. Their mean (+/-SD) age was 65.5+/-9.1 years, and the average duration of hypertension was 12.6+/-5.3 years. We used recursive partitioning to assess the probability that antihypertensive therapy would be increased at a given clinic visit using several variables. We then used these predictions to define the intensity of treatment for each patient during the study period, and we examined the associations between the intensity of treatment and the degree of control of blood pressure. RESULTS: Approximately 40 percent of the patients had a blood pressure of > or =160/90 mm Hg despite an average of more than six hypertension-related visits per year. Increases in therapy occurred during 6.7 percent of visits. Characteristics associated with an increase in antihypertensive therapy included increased levels of both systolic and diastolic blood pressure at that visit (but not previous visits), a previous change in therapy, the presence of coronary artery disease, and a scheduled visit. Patients who had more intensive therapy had significantly (P<0.01) better control of blood pressure. During the two-year period, systolic blood pressure declined by 6.3 mm Hg among patients with the most intensive treatment, but increased by 4.8 mm Hg among the patients with the least intensive treatment. CONCLUSIONS: In a selected population of older men, blood pressure was poorly controlled in many. Those who received more intensive medical therapy had better control. Many physicians are not aggressive enough in their approach to hypertension.
D R Berlowitz; A S Ash; E C Hickey; R H Friedman; M Glickman; B Kader; M A Moskowitz
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  The New England journal of medicine     Volume:  339     ISSN:  0028-4793     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  1998 Dec 
Date Detail:
Created Date:  1999-01-05     Completed Date:  1999-01-05     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1957-63     Citation Subset:  AIM; IM    
Center for Health Quality, Outcomes, and Economic Research, Bedford Veterans Affairs Hospital, MA 01730, USA.
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MeSH Terms
Ambulatory Care / standards
Blood Pressure*
Decision Support Techniques
Health Services Research
Hospitals, Veterans
Hypertension / drug therapy*,  physiopathology
Office Visits / statistics & numerical data
Outcome and Process Assessment (Health Care)*
Outpatient Clinics, Hospital
Random Allocation
United States
Comment In:
N Engl J Med. 1999 May 20;340(20):1593; author reply 1594-5   [PMID:  10336361 ]
N Engl J Med. 1999 May 20;340(20):1593; author reply 1594-5   [PMID:  10336362 ]
N Engl J Med. 1999 May 20;340(20):1593-5   [PMID:  10336363 ]

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