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Volume 339:1957-1963 December 31, 1998 Number 27 Next

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ABSTRACT

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 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.

Source Information

From the Center for Health Quality, Outcomes, and Economic Research, Bedford Veterans Affairs Hospital, Bedford, Mass. (D.R.B., E.C.H., B.K.); the Health Care Research Unit, Section of General Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston (D.R.B., A.S.A., R.H.F., M.A.M.); and the Department of Mathematics, Boston University, Boston (M.G.).

Address reprint requests to Dr. Berlowitz at the HSR&D Field Program, Bedford Veterans Affairs Hospital, 200 Springs Rd., Bedford, MA 01730.

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Inadequate Management of Blood Pressure in a Hypertensive Population
Sechi L. A., Zingaro L., Bartoli E., Ward H. J., Pinto-Sietsma S.-J., Hillege H. L., Janssen W. M.T., Berlowitz D. R., Ash A. S., Moskowitz M. A.
Extract | Full Text  
N Engl J Med 1999; 340:1593-1595, May 20, 1999. Correspondence

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