title: Antihypertensive treatment and blood pressure control relative to hypertension treatment guidelines.
abstract: OBJECTIVE
  To describe initial antihypertensive management relative to important aspects of JNC7 hypertension guidelines, to identify predictors of receiving JNC7 discordant therapy, and to determine the association between receiving JNC7-concordant antihypertensive treatment and achieving blood pressure (BP) control. This study focused on aspects of the JNC7 guidelines which are consistent with other guidelines that have been published since JNC7.
  
  
  METHODS
  EMR data from eleven multi-specialty medical groups in the US were retrospectively collected between 2008-2011. The study cohort included incident hypertensive patients who received an antihypertensive prescription during the 6-month follow-up period. Patients with existing hypertension were excluded. JNC7-concordance of the prescribed antihypertensive regimen was evaluated. Using multivariable logistic regression, we determined the association between JNC7-concordance and achieving BP control. Additionally, we determined predictors of receiving JNC7-discordant treatment.
  
  
  RESULTS
  14,910 incident hypertensive patients who were treated with an antihypertensive during the 6-month follow-up period were included. Overall, 79.4% patients were prescribed antihypertensive therapy concordant with JNC7; however among patients with stage 2 hypertension, the concordance was found to be 50%. BP control was achieved by 64.1% and 48.5% of patients who received JNC7-concordant and JNC7-discordant therapy, respectively. The overall adjusted odds ratio (95% CI) for BP control and JNC7-concordance was 1.53 (1.40, 1.68). The association was attenuated for cohort members with diabetes, chronic kidney disease (CKD), and stage 2 hypertension. Predictors of receiving JNC7-discordant therapy were congestive heart failure, CKD, and diabetes.
  
  
  CONCLUSIONS
  JNC7-concordance is high overall, but drops substantially when JNC7 recommendations are more demanding (e.g., among patients with stage 2 hypertension and/or CKD, CHF, diabetes). Overall, patients who are prescribed an antihypertensive regimen that is JNC7-concordant are more likely to achieve BP control.
authors.affiliation: American Medical Group Association, Alexandria, VA, USA.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Rowan
authors.forename: John Rick
authors.initials: JR
authors.lastname: Turner
authors.forename: Ankit
authors.initials: A
authors.lastname: Shah
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Spaeder
mesh_terms: D000293:Adolescent; D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure; D005260:Female; D017408:Guidelines as Topic; D049674:History, 21st Century; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D012189:Retrospective Studies
chemical_list: D000959:Antihypertensive Agents
keywords: JNC7; blood pressure control; concordance with hypertension guidelines; hypertension guidelines; pharmacoepidemiology