Treatment of difficult-to-control blood pressure in a multidisciplinary clinic at a public hospital.
Cardiovascular morbidity and mortality in disadvantaged populations remains high. Few innovative strategies or services to treat chronic diseases have been critically analyzed in these patients. We evaluated our initial experiences with a newly established multidisciplinary clinic For the treatment of difficult-to-control hypertension and describe reasons for poor blood pressure control as well as treatment strategies. Patients with blood pressures greater than 140/90 despite concurrent treatment with three or more medications for at least three months were referred to our clinic. Data regarding sociodemographic characteristics, health beliefs and behaviors were collected. Two physicians jointly proposed an explanation for lack of blood pressure control. A multidisciplinary team of physicians, nurses, pharmacists, and nutritionists aggressively assessed and reinforced educational objectives tailored to individual needs. 58% of patients achieved target blood pressure at six months, but 22% were lost to follow-up. The most common reasons for previous treatment failure were volume overload and poor medication adherence. We conclude that a multidisciplinary clinic for difficult-to-control blood pressure can be successful in a large, urban hospital serving a disadvantaged minority population. However, more study is needed to delineate the specific reasons for success and further refine treatment strategies.
Division of General Medicine & Primary Care, Department of Medicine Cook County Hospital and Rush Medical College, Chicago, IL, USA.
Laurent S
LS
Tao
Peter
P
Hart
Emma
E
Edwards
Arthur T
AT
Evans
Eric
E
Whitaker
Pamela
P
Smith
D000328:Adult; D001741:Black or African American; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002641:Chicago; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006779:Hospitals, Public; D006786:Hospitals, Urban; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010044:Outpatient Clinics, Hospital; D010348:Patient Care Team; D015397:Program Evaluation; D013995:Time; D016312:Treatment Refusal
D000959:Antihypertensive Agents