Document Detail

Level of blood pressure above goal and clinical inertia in a Medicaid population.
MedLine Citation:
PMID:  20728422     Owner:  NLM     Status:  MEDLINE    
Failure to adjust hypertension therapy despite elevated blood pressure (BP) levels is an important contributor to lack of BP control. One possible explanation is that small elevations above goal BP are not concerning to clinicians. BP levels farther above goal, however, should be more likely to prompt clinical action. We reviewed 1 year's worth of primary care records of 3742 North Carolina Medicaid recipients 21 years and older with hypertension (a total of 15,516 office visits) to examine variations in hypertension management stratified by level of BP above goal and the association of BP level above goal with documented antihypertensive medication change. Among the 53% of patients not at goal BP, 42% were within 10/5 mm Hg of goal; 11% had a BP 40/20 mm Hg or higher above goal. Higher level of BP above goal was independently associated with antihypertensive medication change. Compared with visits at which BP was less than 10/5 mm Hg above goal, the adjusted odds of medication change were 7.9 (95% Confidence Interval 6.2-10.2) times greater at visits when patients' BP was 40/20 mm Hg or higher above goal. However, even when BP was above goal at this level, treatment change occurred only 46% (95% Confidence Interval 40.2-51.8) of the time.
Anthony J Viera; Dorothee Schmid; Susan Bostrom; Angie Yow; William Lawrence; C Annette DuBard
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2010-08-21
Journal Detail:
Title:  Journal of the American Society of Hypertension : JASH     Volume:  4     ISSN:  1933-1711     ISO Abbreviation:  J Am Soc Hypertens     Publication Date:    2010 Sep-Oct
Date Detail:
Created Date:  2010-10-13     Completed Date:  2011-01-03     Revised Date:  2011-09-13    
Medline Journal Info:
Nlm Unique ID:  101312518     Medline TA:  J Am Soc Hypertens     Country:  United States    
Other Details:
Languages:  eng     Pagination:  244-54     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 American Society of Hypertension. Published by Elsevier Inc. All rights reserved.
Department of Family Medicine, University of North Carolina, Chapel Hill, NC, USA.
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MeSH Terms
Antihypertensive Agents / therapeutic use*
Blood Pressure / drug effects
Hypertension / drug therapy*,  epidemiology*
Life Style
Medicaid / statistics & numerical data*
Middle Aged
Primary Health Care / statistics & numerical data*
United States / epidemiology
Young Adult
Grant Support
Reg. No./Substance:
0/Antihypertensive Agents

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