title: Hypertension control among patients followed by cardiologists.
abstract: BACKGROUND
  Hypertension control is an important and modifiable risk factor for cardiovascular disease. The overall rate of hypertension control among patients followed in cardiology clinics, as well as clinician variability in control rates, is unknown.
  
  
  RESULTS
  We conducted a retrospective cohort study of patients with hypertension (n=5979) routinely followed in a cardiology clinic (n=47 physicians). Overall, 30.3% of patients with hypertension had suboptimal control (blood pressure [BP] ≥ 140/90 mm Hg) at the end of a 13-month follow-up period. Patient-level factors associated with control were younger age, male sex, white ethnicity, having a primary care provider at Duke, private insurance, Medicare/Medicaid, and comorbid diagnoses of heart failure or coronary artery disease. Unadjusted rates of suboptimal BP control among clinicians' clinic patient panels ranged from 16% to 44%. Even after adjusting for patient factors, patients' odds of BP control varied 6-fold, depending on their treating clinician. Using a patient's average BP rather than their most recent BP did not result in significant changes in provider performance. In chart reviews (n=300), clinicians failed to document a plan to address hypertension in 38% of patients with elevated BP in the clinic.
  
  
  CONCLUSIONS
  Up to one-third of patients followed routinely by cardiologists in clinic have suboptimally controlled BP, with wide variability in performance across individual clinicians. This variability, alongside evidence that elevated BP is often not acted on during clinic visits, demonstrates a potential opportunity for quality improvement.
authors.affiliation: Duke University Medical Center, Durham, NC, 27710, USA. navar006@mc.duke.edu
authors.forename: Ann Marie
authors.initials: AM
authors.lastname: Navar-Boggan
authors.forename: Joel C
authors.initials: JC
authors.lastname: Boggan
authors.forename: Judith A
authors.initials: JA
authors.lastname: Stafford
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Muhlbaier
authors.forename: Catherine
authors.initials: C
authors.lastname: McCarver
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D001795:Blood Pressure Determination; D002309:Cardiology / Q000592:standards; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009657:North Carolina; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards; D011237:Predictive Value of Tests; D058996:Quality Improvement; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents