Blood pressure control and factors predicting control in a treatment-compliant male veteran population.
OBJECTIVE
To estimate blood pressure control and identify treatment variables predicting control in treatment-compliant, hypertensive, male veterans.


METHODS
Outpatient clinic of a Veterans Affairs medical center.


METHODS
Retrospective review of computerized patient records over a 12-month period for demographics, comorbidities, patient-specific blood pressure goals, blood pressure history, antihypertensive therapy, and refill history.


METHODS
Two hundred fifty hypertensive men aged 39-90 years whose antihypertensive regimen remained unchanged over 12 months.


RESULTS
The proportion of patients with blood pressures below 160/90 mm Hg was 86%; only 34.8% had pressures below 140/90 mm Hg. Blood pressure control was less common with advancing age (42.1%, 33.7%, and 29.4% for patients aged < 60, 60-75, and > 75 yrs, respectively, p = 0.057 for trend). Treatment intensity was highest in obese men, those aged 60-75 years, and those with a history of chronic heart failure or angina, and lowest in men older than 75 years or with a history of stroke. Blood pressure control was independently associated with therapy with beta-blockers (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.5-10.2, p = 0.005), loop diuretics (OR 4.3, 95% CI 1.6-12.1, p = 0.005), angiotensin-converting enzyme inhibitors (OR 3.1, 95% CI 1.2-8.2, p = 0.025), and long-term simvastatin therapy (OR 3.7, 95% CI 1.9-7.4, p = 0.0001), and with a diagnosis of coronary artery disease (OR 3.2, 95% CI 1.35-7.69, p = 0.009). The relationship between simvastatin therapy and blood pressure control persisted after controlling for the higher treatment intensity in patients taking the drug. Factors predicting poor control included a history of stroke (OR for control 0.36, 95% CI 0.19-0.69, p = 0.002), age over 75 years (OR 0.43, 95% CI 0.18-0.98, p = 0.046), highest low-density lipoprotein tertile (OR 0.37, 95% CI 0.17-0.80, p = 0.013), highest body mass index tertile (OR 0.46, 95% CI 0.21-1.00, p = 0.05), and therapy with two or fewer antihypertensives (OR 0.14, 95% CI 0.04-0.61, p = 0.009).


CONCLUSIONS
In a compliant veteran population, control of blood pressure appeared inadequate but was significantly more likely in those receiving at least three antihypertensive agents. Long-term therapy with simvastatin was independently associated with increased odds of control.
Ambulatory Care Pharmacy Services, Mayo Clinic, Rochester, Minnesota 55905, USA.
Marcel D
MD
Bizien
Sandra G
SG
Jue
Chad
C
Panning
Barry
B
Cusack
Teri
T
Peterson
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000187:drug effects* / Q000502:physiology*; D015897:Comorbidity; D003710:Demography; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010347:Patient Care Planning; D010349:Patient Compliance; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D019821:Simvastatin / Q000627:therapeutic use; D016896:Treatment Outcome; D014728:Veterans
D019821:Simvastatin