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56. Patient Factors Related to Poor Blood Pressure Control

HB Bosworth, Durham VAMC; J Hoff, Durham VAMC; T Box, Durham VAMC; M Olsen, Durham VAMC; M Orr, Durham VAMC; K Goldberg, Durham VAMC; EZ Oddone, Durham VAMC

Objectives: To examine what psychosocial characteristics are associated with poor blood pressure (BP) control in a sample of hypertensive veterans.

Methods: A pool of approximately 5,000 eligible patients who had 1) an outpatient diagnosis of hypertension, 2) a primary care physician, 3) a prescribed anti-hypertensive medication, and 4) at least one visit to the Durham VAMC between 1/1/99 and 12/31/99, was identified. 165 patients were randomly selected from this pool (100% participation). Demographic, clinical and psychosocial factors were assessed during an interview. Blood pressure control - defined as <140/90 mm Hg - at the outpatient clinic visit during the baseline interview was the outcome measure.

Results: The sample consisted of 40% African American, 60% Caucasian and was, on average, 64 years of age. Only 41% had adequate blood pressure control (38% of African Americans and 43% of Caucasians), despite a majority of the sample (75%) having a diagnosis of hypertension for 5 or more years. Patients with poor blood pressure control were on average 4 years older, and 75% of these patients reported at least one side effect attributable to their antihypertensive medication. Patients with poor blood pressure control reported significantly moreproblems following their physicians' recommendations regarding treatment of hypertension (p<0.05). Patients with poor blood pressure control tended to be less compliant and reported being careless with taking their blood pressure medication (19% vs. 8% p<0.056).

Conclusions: Hypertension in the VA continues to be undertreated, despite the disease being one of the major modifiable risk factors for stroke and one of the major risk factors for CAD, CHF, and renal disease. Hypertensive patients with poor blood pressure control tended to be older, report more side effects, have more difficulties following their physicians' recommendations, and report being less compliant with their antihypertensive medication regimens.

Impact: Despite the fact that antihypertensive medications can significantly reduce the impact of hypertension on stroke and CAD, a majority of adults examined in this sample continue to exhibit poor BP control. One of the national health objectives for the year 2010 is to increase the proportion of patients with controlled BP to at least 50%, and the VA has considered the reduction of hypertension an important goal by elevating it to the level of a VISN Director Performance Standard. Our study indicated that there remains more work to meet these goals, and the data collected will be used to develop a patient/physician intervention to improve the rates of BP control.