Factors associated with uncontrolled hypertension in an affluent, elderly population.
OBJECTIVE
To explore demographic, economic, and treatment-related associations with uncontrolled hypertension in a relatively affluent, community-dwelling population.


METHODS
Two home surveys of 655 and 432 subjects with a diagnosis of hypertension were completed in 1995 and 1999, respectively. Trained surveyors recorded medication history plus demographic and socioeconomic variables, as well as several measurements of blood pressure in the home. Uncontrolled hypertension was defined according to guidelines set forth by the Sixth Report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Odds ratios for observing an elevated blood pressure given the patients' medication history, income, insurance coverage, demographic variables, and concomitant disease were estimated using multivariable logistic regression.


RESULTS
On both occasions, >60% of the study population had an average blood pressure that was above recommended levels. Diuretic therapy alone (1995 survey) or in combination with an angiotensin-converting enzyme inhibitor (1999 survey) decreased the odds ratio for uncontrolled hypertension by 39% (p = 0.027) and 62% (p = 0.005), respectively. Lack of prescription drug insurance and a history of arthritis had negative effects, increasing the odds ratio for uncontrolled hypertension by more than twofold (p < 0.05).


CONCLUSIONS
Uncontrolled hypertension occurs commonly among elderly patients notwithstanding a relatively high standard of living. The choice of medication, presence of concomitant disease, and availability of insurance may be important factors influencing blood pressure control.
Inciardi
John F
JF
Department of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco, CA 94143, USA. jinciar@itsa.ucsf.edu
McMahon
Kay
K
Sauer
Barbara L
BL
D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000191:economics* / Q000627:therapeutic use; D001168:Arthritis / Q000150:complications; D001794:Blood Pressure; D003625:Data Collection; D004232:Diuretics / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000191:economics* / Q000208:ethnology; D007182:Income; D019458:Insurance Coverage; D007348:Insurance, Health; D008297:Male; D017533:Marital Status; D016017:Odds Ratio; D012959:Socioeconomic Factors
D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D004232:Diuretics