Understanding uncontrolled hypertension: is it the patient or the provider?
The relative contributions of adherence and treatment intensity to blood pressure (BP) control are not well understood. The authors studied patients with uncontrolled hypertension (N=410) from 3 primary care clinics in the Veterans Affairs (VA) medical system. A questionnaire was used to assess patient adherence to therapy, and VA system pharmacy fills were used to assess the intensity of the antihypertensive regimen. At baseline, an inadequate antihypertensive regimen was implicated as the most probable reason for uncontrolled BP in a majority of patients (72%), while nonadherence could only be implicated in 13%. In multivariate longitudinal analyses, patients who had an increase in their medical treatment during the study had lower final diastolic BP levels compared with the patients who did not (-3.70 mm Hg; P<.05). While patient adherence to therapy plays a role, vigorous clinical management by the clinician is a more important contributor to BP control.
Rose
Adam J
AJ
Center for Health Quality, Outcomes, and Economic Research, Bedford VA Medical Center, Bedford, MA 01730, USA. adamrose@bu.edu
Berlowitz
Dan R
DR
Orner
Michelle B
MB
Kressin
Nancy R
NR
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D011307:Drug Prescriptions / Q000592:standards*; D006282:Health Personnel; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008875:Middle Aged; D011446:Prospective Studies; D017211:Treatment Failure; D016312:Treatment Refusal / Q000706:statistics & numerical data*
D000959:Antihypertensive Agents