Hypertension in older urban Native-American primary care patients.
OBJECTIVE
To examine hypertension and its management in a population of older urban American Indians and Alaska Natives (AI/ANs).


METHODS
Retrospective cohort study using medical record review.


METHODS
Urban health clinic serving predominantly AI/ANs in the Pacific Northwest.


METHODS
Five hundred twenty-four AI/ANs aged 50 and older seen between 1994 and 1995.


METHODS
Frequency of diagnosed hypertension, undiagnosed hypertension, comorbid conditions, hypertension treatment, control, and quality of care.


RESULTS
The prevalence of diagnosed hypertension was 38%, and the prevalence of possible undiagnosed hypertension was 23%. Patients with diagnosed hypertension were more likely to be obese (age-adjusted odds ratio (OR) = 3.5), have diabetes mellitus (DM) (OR = 2.2), depression (OR = 1.7), heart disease (OR = 3.8), or renal disease (OR = 5.6) than patients without hypertension. Undiagnosed hypertension was inversely associated with number of health problems (OR = 0.8). Eighty-one percent of diagnosed patients were treated pharmacologically, but no factors associated with nontreatment were identified. Diuretic and beta-blocker usage was low. Patients with DM used angiotensin-converting enzyme inhibitors more frequently than patients without DM (OR = 2.4). Blood pressure was well controlled in 37%, with men being less well controlled than women (OR = 0.5). Serum cholesterol, creatinine, and retinal screening were performed more often than urinalyses or electrocardiograms. Lifestyle-modification counseling was uncommon. Number of health problems was the most common factor associated with screening tests for end-organ disease.


CONCLUSIONS
Few studies have examined the care of older urban AI/ANs. Improvements are needed in adherence to recommendations for the detection, management, and monitoring of hypertension and its complications in older urban AI/ANs.
Rhoades
Dorothy A
DA
Native Elder Research Center, University of Colorado Health Sciences Center, Denver, Colorado, USA.
Buchwald
Dedra
D
D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000208:ethnology* / Q000628:therapy; D007198:Indians, North American / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011320:Primary Health Care / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care / Q000592:standards; D011787:Quality of Health Care; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data