Is blood pressure adequately controlled in general medicine clinics?

Area of Science:

• Geriatric Medicine
• Cardiology
• Clinical Pharmacy

Background:

• Essential hypertension is a significant health concern in the elderly population.
• Adequate blood pressure (BP) control is crucial for preventing cardiovascular complications in elderly essential hypertensives (EHT).
• Comparing management strategies between general medicine (GM) and specialized hypertension (HT) clinics is important for optimizing patient outcomes.

Purpose of the Study:

• To compare the adequacy of BP management for EHT between GM and HT clinics at Siriraj Hospital.
• To identify factors contributing to suboptimal BP control in EHT patients.

Main Methods:

• A comparative study design was employed, enrolling EHT patients from GM and HT clinics.
• Adequacy of BP management (ADBP) was defined by specific diastolic blood pressure (DBP) thresholds (< 85 mmHg for diabetics, < 90 mmHg for non-diabetics).
• Statistical analysis, including odds ratios (OR) and confidence intervals (CI), was used to compare outcomes and identify risk factors.

Main Results:

• Patients at the HT clinic demonstrated significantly higher rates of ADBP (69.8%) compared to those at the GM clinic (49.3%; p = 0.02).
• Physician unwillingness to modify drug regimens when target BP was unmet was a significant independent risk factor for poor BP control (p = 0.003).
• The odds of poor BP control were substantially higher (OR = 9.7) when physicians were reluctant to adjust medications.

Conclusions:

• BP management for EHT is less adequate in GM clinics compared to specialized HT clinics.
• Strategies to enhance BP normalization in EHT patients require addressing physician behavior regarding medication adjustments.
• Improving EHT management necessitates a multi-faceted approach, potentially involving enhanced training and protocols for GM physicians.