Determinants of uncontrolled hypertension in an African-American population.
OBJECTIVE
The purpose of this study was to assess blood pressure control and the determinants of uncontrolled blood pressure among African-American hypertensive patients.


METHODS
Baseline clinical data were collected as part of a nationwide hypertension quality improvement initiative. An analysis of determinants of uncontrolled blood pressure was conducted using logistic regression for the following variables: angina, congestive heart failure, coronary artery disease, diabetes, family history of cardiovascular disease or stroke, hyperlipidemia, left ventricular hypertrophy, and tobacco use.


METHODS
10 managed care/advanced physician organizations.


METHODS
Pharmacy and medical claims covering 1,965,000 lives were reviewed and 292,996 members with a hypertension-related claim were identified between June 1, 1998 and July 1, 2001. A random sample (N = 5,935) was selected for chart review. The present analysis was conducted on the subset of African-American patients (N = 440) included in this sample.


RESULTS
Approximately 66% of the African-American patients were female, the mean age was 60.4 years, 47.8% had dyslipidemia, and 31.4% had diabetes. Approximately 64% had uncontrolled hypertension. Patients with diabetes were 3 times more likely to have uncontrolled blood pressure as were patients without diabetes (OR = 2.92; P < .0001).


CONCLUSIONS
Blood pressure control in the African-American population is lower than the Healthy People 2010 goal of 50%. African Americans with hypertension and diabetes are at an increased risk for uncontrolled blood pressure. Treating this high-risk population more aggressively may reduce long-term complications and decrease mortality.
Jackson
James H
JH
Applied Health Outcomes, Division of Navigant Consulting, Inc., Tampa, Florida 33609, USA. jjackson@applied-outcomes.com
Bramley
Thomas J
TJ
Chiang
Tina H
TH
Jhaveri
Vishu
V
Frech
Feride
F
D000328:Adult; D001741:Black or African American; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002908:Chronic Disease; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000208:ethnology* / Q000517:prevention & control; D008297:Male; D008329:Managed Care Programs / Q000592:standards*; D008875:Middle Aged; D011785:Quality Assurance, Health Care; D014481:United States / Q000453:epidemiology
D000806:Angiotensin-Converting Enzyme Inhibitors