2021. Therapeutic Goal Attainment in Patients with Hypertension and Dyslipidemia
Michael L Johnson, PhD, Houston Center for Quality of Care and Utilization Studies, Houston VAMC and Baylor College of Medicine, RJ Beyth, Houston Center for Quality of Care and Utilization Studies, Houston VAMC and Baylor College of Medicine, K Pietz,
Houston Center for Quality of Care and Utilization Studies, Houston VAMC and Baylor College of Medicine, DS Battleman,
Objectives: To estimate the attainment of therapeutic goals in patients with hypertension and dyslipidemia overall and separately among patients with diabetes.
Methods: Computerized diagnostic, pharmacy, laboratory and vital sign information was linked and searched for all patients seen (N=352,603) over three years (October 1, 1998 to September 30, 2001) at six medical centers of VISN 16. Therapeutic goals for blood pressure and LDL were defined by JNC-VI and NCEP ATP-III criteria, and were measured after one year of follow-up in an inception cohort (n=42,676) of cases with no prior treatment.
Results: Forty-one percent of patients with hypertension reached target goals for blood pressure, and 24.9% of patients with dyslipidemia reached target LDL. Among patients with diabetes, these rates fell to 29.3% and 9.9%, respectively. Among patients with concomitant hypertension and dyslipidemia, 13.3% overall and 9.9% of diabetics attained both target goals. Rates of MI tripled in patients with both hypertension and dyslipidemia compared to patients with either condition alone (8.5% compared to 2.4% and 2.8%, respectively). Treatment patterns varied substantially within disease groups.
Conclusions: In these highly prevalent conditions with severe cardiovascular disease risk, treatment varied widely, and over half of all patients never attained therapeutic goals.
Impact: Although treatment efficacy is well-established in clinical trials, there is substantial room for improvement in effectiveness at the population and healthcare system level. Further research is needed to examine patient demographic, clinical and lifestyle factors, and provider structural and process factors determining variation in treatment and outcomes.