title: Blood pressure control among US veterans: a large multiyear analysis of blood pressure data from the Veterans Administration health data repository.
abstract: BACKGROUND
  Hypertension treatment and control remain low worldwide. Strategies to improve blood pressure control have been implemented in the United States and around the world for several years. This study was designed to assess improvement in blood pressure control over a 10-year period in a large cohort of patients in the Department of Veterans Affairs.
  
  
  RESULTS
  A cohort of 582 881 hypertensive patients and 260 924 normotensive individuals treated in 15 Department of Veterans Affairs medical centers between 2000 and 2010 were examined. Strategies used system-wide included blood pressure control as a performance measure, automatic notification to healthcare providers, electronic reminders, and a systematic revisit schedule. The main outcome measure was the percentage of hypertensive patients whose hypertension was controlled and the level of blood pressure each month. In the hypertensive cohort (mean age 62.9±13.4 years, 96.0% male), 52.3% of patients were white, 25.1% were black, and 21.1% were Hispanic. Blood pressure control rates improved from 45.7% in September 2000 to 76.3% in August 2010. Improvements were similar across ethnic, racial, age, and sex groups. Average systolic/diastolic blood pressure decreased from 142.6/77.1 mm Hg in 2000 to 131.2/74.8 mm Hg in 2010, a decrease of 11.3/2.3 mm Hg (P<0.0001 for both). Systolic and diastolic blood pressures were lower in summer than in winter, and this trend continued through 2010. On average, control rates increased by 3.0% per year and were 6.8% higher in summer than in winter.
  
  
  CONCLUSIONS
  High rates of blood pressure control can be achieved in all age and ethnic groups and in both sexes.
authors.affiliation: Veterans Affairs Medical Center, 50 Irving St NW, Washington, DC 20422, USA. Ross.Fletcher@va.gov
authors.forename: Ross D
authors.initials: RD
authors.lastname: Fletcher
authors.forename: Richard L
authors.initials: RL
authors.lastname: Amdur
authors.forename: Robert
authors.initials: R
authors.lastname: Kolodner
authors.forename: Chris
authors.initials: C
authors.lastname: McManus
authors.forename: Ronald
authors.initials: R
authors.lastname: Jones
authors.forename: Charles
authors.initials: C
authors.lastname: Faselis
authors.forename: Peter
authors.initials: P
authors.lastname: Kokkinos
authors.forename: Steven
authors.initials: S
authors.lastname: Singh
authors.forename: Vasilios
authors.initials: V
authors.lastname: Papademetriou
mesh_terms: D000368:Aged; D044383:Black People / Q000706:statistics & numerical data; D001794:Blood Pressure / Q000187:drug effects*; D015331:Cohort Studies; D016208:Databases, Factual / Q000706:statistics & numerical data; D057286:Electronic Health Records / Q000706:statistics & numerical data; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000208:ethnology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012621:Seasons; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data; D014728:Veterans / Q000706:statistics & numerical data*; D044465:White People / Q000706:statistics & numerical data; D001741:Black or African American