Correlates of controlled hypertension in indigent, inner-city hypertensive patients.
OBJECTIVE
To identify correlates of controlled hypertension in a largely minority population of treated hypertensive patients.


METHODS
Case-control study.


METHODS
Urban, public hospital.


METHODS
A consecutive sample of patients who were aware of their diagnosis of hypertension for at least 1 month and had previously filled an antihypertensive prescription. Control patients had a systolic blood pressure (SBP) < or = 140 mm Hg and diastolic blood pressure (DBP) < or = 90 mm Hg, and case patients had a SBP > or = 180 mm Hg or DBP > or = 110 mm Hg.


RESULTS
Control subjects had a mean blood pressure (BP) of 130/80 mm Hg and case subjects had a mean BP of 193/106 mm Hg. Baseline demographic characteristics between the 88 case and the 133 control subjects were not significantly different. In a logistic regression model, after adjusting for age, gender, race, education, owning a telephone, and family income, controlled hypertension was associated with having a regular source of care (odds ratio [OR] 7.93; 95% confidence interval [CI] 3.86, 16.29), having been to a doctor in the previous 6 months (OR 4.81; 1.14, 20.31), reporting that cost was not a deterrent to buying their antihypertensive medication (OR 3.63; 1.59, 8.28), and having insurance (OR 2.15; 1.02, 4.52). Being compliant with antihypertensive medication regimens was of borderline significance (OR 1.96; 0.99, 3.88). A secondary analysis found that patients with Medicaid coverage were significantly less likely than the uninsured to report cost as a barrier to purchasing antihypertensive medications and seeing a physician.


CONCLUSIONS
The absence of out-of-pocket expenditures under Medicaid for medications and physician care may contribute significantly to BP control. Improved access to a regular source of care and increased sensitivity to medication costs for all patients may lead to improved BP control in an indigent, inner-city population.
Ahluwalia
J S
JS
Department of Medicine, Emory University School of Medicine, Atlanta, GA 30303, USA.
McNagny
S E
SE
Rask
K J
KJ
D000959:Antihypertensive Agents / Q000191:economics / Q000627:therapeutic use*; D001795:Blood Pressure Determination; D003627:Data Interpretation, Statistical; D005260:Female; D017048:Health Care Costs; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006786:Hospitals, Urban; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000191:economics; D008297:Male; D008484:Medicaid; D008489:Medical Indigency; D008875:Middle Aged; D008913:Minority Groups; D010353:Patient Education as Topic; D014481:United States
D000959:Antihypertensive Agents