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Evaluating hypertension control in a managed care setting.

M Alexander¹, I Tekawa, E Hunkeler

¹Division of Research, Kaiser Permanente Medical Care Program, Northern California Region, Oakland 94611-5714, USA. mxa@dor.kaiser.org

Archives of Internal Medicine

|December 22, 1999

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Assessing blood pressure (BP) control in hypertension patients using the last recorded BP measurement is feasible and comparable to using the mean BP. More aggressive hypertension management is recommended, particularly for systolic BP.

Area of Science:

Cardiovascular Medicine
Public Health
Health Services Research

Background:

Retrospective cohort study of adult hypertension patients within a health maintenance organization.
Investigated feasibility of documenting blood pressure control.
Compared various measures for defining blood pressure control.

Purpose of the Study:

To assess the feasibility of documenting blood pressure control in a large health maintenance organization.
To compare different methods for defining blood pressure control among hypertensive patients.

Main Methods:

Evaluated three blood pressure control criteria: systolic <140 mmHg, diastolic <90 mmHg, and combined.
Examined four assessment methods: control at 75% of visits, 50% of visits, mean BP, and last recorded BP.

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Main Results:

Control rates were similar using mean BP, last recorded BP, or control at >=50% of visits.
More stringent criteria (control at >=75% of visits) yielded substantially lower control rates.
Combined BP control at >=75% of visits was half that of other methods.

Conclusions:

The last BP measurement is a feasible and comparable method to mean BP for assessing hypertension control.
Significant room for improvement in blood pressure control exists within health maintenance organizations.
Clinicians should adopt more aggressive hypertension management, emphasizing systolic blood pressure.