2054. Hypertesion Control:
How Well Are We Doing?
AM Borzecki, CHQOER, Bedford VAMC, and Boston University School of
Public Health, AT Wong, CHQOER, Bedford VAMC, and Boston University
School of Public Health, EC Hickey, CHQOER, Bedford VAMC, and Boston
University School of Public Health, AS Ash, Section of General Internal
Medicine, Boston Medical Center and Boston University School of Medicine, DR
Berlowitz, CHQOER, Bedford VAMC, and Boston University School of Public
Health, Section of General Internal Medicine, Boston Medical Center and Boston
University School of Medicine
Objectives: We previously
documented that over 65% of hypertensive veterans had poorly controlled blood
pressure (BP) and poor control was associated with providers being
under-aggressive in increasing antihypertensive medications. Since then the VA
has devoted considerable resources toward improving care. The current study
determined BP control in a recent cohort of hypertensive veterans; compared this
to the previous cohort and examined whether hypertension treatment practices,
defined by the frequency of antihypertensive medication increases, have changed
over time.
Methods: We abstracted
1999 outpatient chart data including visit type, BP, comorbidities, and
medications for 981 randomly selected hypertensive veterans at 10 VA sites.
We examined BP control overall, in subgroups with diabetes and renal
disease, and compared control with a previously studied sample of 800 veterans
from 1990-1995. Lastly, we compared the frequency of antihypertensive medication
increases in the two samples, accounting for current BP levels, and other
factors associated with therapy increases.
Results: Mean BPs were
significantly lower in 1999 versus ‘90-‘95; the mean systolic drop was 3.1
and reached 13.7 mm Hg for those with both diabetes and renal disease. Larger
decreases were seen in mean diastolic BPs.
In 1999, 57% had a BP >=140/90 versus 69% in ‘90-‘95
(p<0.0001). In 1999, diabetics had analogous control to non-diabetics with
60% >=140/90; renal disease patients had better control than those without;
43% versus 58% >=140/90 (p=0.01). Patients
with diabetes, renal disease or both had better control in 1999 than in
‘90-‘95, (p<0.0001 in all cases). More
1999 visits were associated with medication increases compared to ‘90-‘95
both overall (25% versus 11%) and when considering specific factors associated
with increases.
Conclusions: BP control
has improved in the VA both overall and in patients with diabetes and renal
disease. This is likely due to more aggressive treatment.
However, most patients still exceed recommended levels and diabetics had
similar control to non-diabetics, rather than guideline-recommended tighter
control.