Hypertension control: How well are we doing?

Purpose of study: Studies have consistently shown that most patients with established hypertension have poorly controlled blood pressure. Most of these are based on patient data predating the JNC VI guidelines and do not consider the importance of tighter control in certain subgroups. We sought to determine the adequacy of BP control in Veterans Affairs (VA) patients with hypertension and to determine level of control in subgroups with diabetes and renal disease in the post JNC VI era.

Methods: At each of 10 VA sites, we randomly selected approximately 100 patients with a diagnosis of hypertension. We undertook a retrospective chart review for the period January 1 to December 31, 1999, abstracting data on visit type, blood pressure (BP), comorbidities, and medications. We supplemented this with information from VA administrative databases. We examined level of BP control based on the last BP available for the year, in all patients and in subgroups with diabetes and renal disease attending primary care and medical subspecialty clinics. We compared these groups and looked at differences between sites.

Results: Of our total sample of 981, 23% of patients had a BP ⩾160/90; 57% had a BP ⩾140/90. For those ⩾140/90, the range among sites was 50–66% but there was no significant (NS) difference between sites (p=0.3). Of our subsample of 338 patients with diabetes, 25% had a BP ⩾ 160/90, 60% had a BP ⩾140/90 and 78% had a BP ⩾130/85. /, There was NS difference in level of control between non-diabetics and diabetics. Of diabetics with renal disease (N=34), 71% had a BP ⩾130/85 and 79% had a BP >125/75; (NS difference compared to diabetics without renal disease, or non-diabetics with renal disease). Of non-diabetics with renal disease (N=33), the respective percentages were 64 and 79; (NS difference versus hypertensives without renal disease).

Conclusions: Despite a growing awareness of the importance of blood pressure control both within the VA and without, a large proportion of VA hypertensive patients remain suboptimally controlled. Further, despite recent guidelines recommending tighter control for important subgroups they are likewise poorly controlled.