High-risk patients with hypertension: Are we doing enough? |
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| Institution: | 1. Xcenda, Palm Harbor, Florida, USA;2. Section of Cardiology; Director, Clinical Research, Advocate Health Care, Chicago, Illinois USA;3. Austin Regional Clinic, Austin, Texas, USA;4. Evidence Based Medicine, Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA;1. University of Medicine and Pharmacy “Carol Davila,” Euroecolab, Bucharest, Romania;2. Emergency Institute of Cardiovascular Diseases “Prof. Dr. C. C. Iliescu,” Bucharest, Romania;1. Jiyugaoka Medical Clinic, Internal Medicine, Obihiro, Japan;2. Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan;3. Department of Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan;4. Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Sagamihara, Japan;5. Department of Internal Medicine, Niigata University, Faculty of Medicine, Niigata, Japan;1. The George Institute for Global Health, University of Oxford, Oxford, UK;2. Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK;3. Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK;4. King''s College Hospital NHS Foundation Trust, London, UK;5. The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia;1. Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY;2. Division of Vascular and Endovascular Surgery, Boston University School of Medicine, Boston Medical Center, Boston, Mass;3. Division of Cardiac, Thoracic, and Vascular Surgery, New York Presbyterian/Columbia University Irving Medical Center/Columbia University College of Physicians and Surgeons, New York, NY |
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| Abstract: | Despite the increasing risk of cardiovascular disease, especially in patients with multiple risk factors, blood pressure (BP) control remains suboptimal. This study investigated real-world BP goal attainment and prescribing patterns for high-risk patients. A retrospective chart review study was conducted in patients treated by eight large primary care physician group practices between December 2003 and May 2006. A total of 1,917 hypertensive patients were identified with ≥1 risk factors: African-American ethnicity (634); diabetes (851); advanced age (1,123); body mass index (BMI) 25 kg/m2 (1,614). BP control rate was 46% overall, and similar in the advanced age and overweight/obese subpopulations, but substantially lower (28%) in the diabetic subpopulation. Systolic blood pressure ≥20 mm Hg above the Joint National Committee on Prevention, Detection, Evaluation, and Treatment Report recommendation was found in 13% of the overall, advanced age and overweight/obese subpopulations, and in 20% of diabetics and 18% of African-Americans. Overall, 62% of patients received ≥2 antihypertensive while 36% of diabetics, 31% of African-Americans, 28% of advanced age, and 26% of overweight/obese patients received ≥3 antihypertensive classes. Despite availability of multiple antihypertensive classes, BP control rates were still suboptimal in this study's high-risk patients. There is a need for awareness and more aggressive treatment in high-risk patients given their increased risk of poor outcomes. |
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