title: High-risk patients with hypertension: Are we doing enough?
abstract: Despite the increasing risk of cardiovascular disease, especially in patients with multiple risk factors, blood pressure (BP) control remains suboptimal. This study investigated real-world BP goal attainment and prescribing patterns for high-risk patients. A retrospective chart review study was conducted in patients treated by eight large primary care physician group practices between December 2003 and May 2006. A total of 1,917 hypertensive patients were identified with >/=1 risk factors: African-American ethnicity (634); diabetes (851); advanced age (1,123); body mass index (BMI) 25 kg/m(2) (1,614). BP control rate was 46% overall, and similar in the advanced age and overweight/obese subpopulations, but substantially lower (28%) in the diabetic subpopulation. Systolic blood pressure >/=20 mm Hg above the Joint National Committee on Prevention, Detection, Evaluation, and Treatment Report recommendation was found in 13% of the overall, advanced age and overweight/obese subpopulations, and in 20% of diabetics and 18% of African-Americans. Overall, 62% of patients received >/=2 antihypertensive while 36% of diabetics, 31% of African-Americans, 28% of advanced age, and 26% of overweight/obese patients received >/=3 antihypertensive classes. Despite availability of multiple antihypertensive classes, BP control rates were still suboptimal in this study's high-risk patients. There is a need for awareness and more aggressive treatment in high-risk patients given their increased risk of poor outcomes.
authors.affiliation: Xcenda, Palm Harbor, Florida, USA.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Chiao
authors.forename: John
authors.initials: J
authors.lastname: Sobolski
authors.forename: Russ
authors.initials: R
authors.lastname: Krienke
authors.forename: Ken S
authors.initials: KS
authors.lastname: Wong
authors.forename: Homa B
authors.initials: HB
authors.lastname: Dastani
authors.forename: Brian
authors.initials: B
authors.lastname: Nightengale