title: Hypertension guideline adherence among nursing home patients.
abstract: BACKGROUND
  Adherence to hypertension guidelines in the outpatient setting is low.
  
  
  OBJECTIVE
  To evaluate adherence to JNC VII guidelines in nursing home patients.
  
  
  METHODS
  Data were obtained from the 2004 National Nursing Home Survey (NNHS), a nationally representative sample of US nursing homes. Patients with hypertension were identified using ICD-9 codes. Adherence to JNC VII guidelines was defined as the use of a thiazide diuretic in patients without a compelling indication for a different class of antihypertensive medication, such as diabetes, chronic kidney disease, coronary artery disease, congestive heart failure, or a history of stroke.
  
  
  METHODS
  There were 13,507 patients in the 2004 NNHS survey, of whom 7,129 had hypertension.
  
  
  RESULTS
  Of these 7,129 hypertensive patients, only 12.6% were on a thiazide. Out of the 7,129 hypertensive patients, 3,113 did not have diabetes, chronic kidney disease, coronary artery disease, congestive heart failure, or a history of stroke. Of these 3,113 patients, only 13.9% were on a thiazide. After excluding patients with a potential contraindication to a diuretic, such as hospice care or incontinence, only 18% were prescribed a thiazide. Of the 3,113 patients, 1,148 were on a single class of antihypertensive and more were prescribed a beta blocker, ACE inhibitor, calcium channel blocker, loop diuretic, and ARB than a thiazide diuretic.
  
  
  CONCLUSIONS
  Adherence to hypertension guidelines among nursing home patients is low. The appropriate use of thiazide diuretics could reduce costs and improve blood pressure control and patient outcomes.
authors.affiliation: Case Western Reserve University, Cleveland, OH, USA. pedrawz00@yahoo.com
authors.forename: Paul E
authors.initials: PE
authors.lastname: Drawz
authors.forename: Cristina
authors.initials: C
authors.lastname: Bocirnea
authors.forename: Katarina B
authors.initials: KB
authors.lastname: Greer
authors.forename: Julian
authors.initials: J
authors.lastname: Kim
authors.forename: Florian
authors.initials: F
authors.lastname: Rader
authors.forename: Patrick
authors.initials: P
authors.lastname: Murray
mesh_terms: D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D009735:Nursing Homes; D017410:Practice Guidelines as Topic; D049993:Sodium Chloride Symporter Inhibitors / Q000627:therapeutic use
chemical_list: D000959:Antihypertensive Agents; D049993:Sodium Chloride Symporter Inhibitors