title: Predisposing factors for severe, uncontrolled hypertension in an inner-city minority population.
abstract: BACKGROUND
  Hypertensive emergency and urgent hypertension are the most severe forms of uncontrolled hypertension and are now seen predominantly in poor, minority populations. We studied the characteristics of the medical care received by patients with these conditions in order to identify risk factors for severe, uncontrolled hypertension.
  
  
  METHODS
  Using a case-control study design, we interviewed 93 patients with severe, uncontrolled hypertension who presented in the hospital emergency room and 114 control patients with hypertension; both groups were seen at two New York City hospitals from 1989 through 1991. All the patients were black or Hispanic. Multiple logistic-regression models were used to adjust for age, sex, race or ethnic background, education, smoking status, alcohol-related problems, and use of illicit drugs during the previous year.
  
  
  RESULTS
  After additional adjustment for lack of health insurance, severe, uncontrolled hypertension was found to be more common among patients who had no primary care physician (adjusted odds ratio, 3.5; 95 percent confidence interval, 1.6 to 7.7) and among those who did not comply with treatment for their hypertension (adjusted odds ratio, 1.9; 95 percent confidence interval, 1.4 to 2.5). Lack of health insurance was marginally associated with severe, uncontrolled hypertension (adjusted odds ratio, 1.9; 95 percent confidence interval, 0.8 to 4.6) after adjustment for lack of a primary care physician and noncompliance with antihypertensive treatment. Patients without a primary care physician and without health insurance were more likely to have their blood pressure checked and receive prescriptions for blood-pressure medications in emergency rooms than in physicians' offices or clinics.
  
  
  CONCLUSIONS
  Characteristics of both the health care system and patients' behavior are associated with severe, uncontrolled hypertension. Improving access to primary care physicians, through health insurance or other means, may be an effective strategy for improving control of hypertension in disadvantaged minority populations.
authors.affiliation: Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY.
authors.forename: S
authors.initials: S
authors.lastname: Shea
authors.forename: D
authors.initials: D
authors.lastname: Misra
authors.forename: M H
authors.initials: MH
authors.lastname: Ehrlich
authors.forename: L
authors.initials: L
authors.lastname: Field
authors.forename: C K
authors.initials: CK
authors.lastname: Francis
mesh_terms: D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000150:complications; D016022:Case-Control Studies; D004630:Emergencies; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000209:etiology*; D006974:Hypertension, Malignant / Q000453:epidemiology / Q000209:etiology; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D008913:Minority Groups; D015999:Multivariate Analysis; D009519:New York City / Q000453:epidemiology; D016017:Odds Ratio; D010349:Patient Compliance; D011204:Poverty Areas; D011320:Primary Health Care; D019966:Substance-Related Disorders / Q000150:complications; D014505:Urban Population