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Effective hypertension control in inner city blacks
S Spitalewitz1, E L Parnes, J G Porush
1Division of Nephrology and Hypertension, Brookdale Hospital Medical Center, Brooklyn, NY 11212.
Insights
Patients with resistant hypertension had controlled blood pressure in 82% of cases. Factors like missed appointments and psychosocial issues impacted control in the remaining 18% of patients.
Area of Science:
- Cardiology
- Internal Medicine
- Public Health
Background:
- Resistant hypertension affects a significant patient population.
- Effective management strategies are crucial for controlling blood pressure and preventing complications.
Purpose of the Study:
- To evaluate the outcomes of patients with resistant hypertension treated at a specialized clinic.
- To identify factors associated with blood pressure control in this patient group.
Main Methods:
- Retrospective review of 105 randomly selected patients from a resistant hypertension clinic.
- Comparison of demographic, clinical, and treatment data between patients with controlled (Group I) and uncontrolled (Group II) diastolic blood pressure (<90 mm Hg).
Main Results:
- 82% of patients achieved controlled diastolic blood pressure (Group I).
- Group II patients showed substantial improvement but remained uncontrolled; they had significantly more missed visits (p<0.01) and lower medication compliance, often due to psychosocial issues.
- While medication availability was higher in Group II (Medicaid recipients), this did not ensure better control.
Conclusions:
- Specialized clinics can achieve good blood pressure control in a majority of resistant hypertension cases.
- Missed appointments, poor medication compliance, and psychosocial factors are significant barriers to achieving blood pressure control in a subset of patients.
- Addressing these non-clinical factors is essential for optimizing hypertension management.
Abstract:
A clinic for patients with "resistant" hypertension was established and patients were followed by one physician, nurse, and secretary. The records of 105 randomly chosen patients out of 700 were reviewed. In 86 of 105 (82%), diastolic blood pressure was controlled (less than 90 mm Hg) (group I), but in 19 patients, after 54 +/- 6 (mean +/- standard error) months, it remained greater than 90 mm Hg (group II) with substantial improvement in 53% (10 of 19 patients). The two groups were similar in age (57 +/- 1 vs 54 +/- 3 years), race (84% vs 74% blacks), and sex (75% vs 86% female). The entry blood pressures in groups I and II were similar, 170 +/- 3/101 +/- 1 and 167 +/- 6/105 +/- 3 mm Hg, respectively. Last visit blood pressure was 130 +/- 1/79 +/- 1 in group I, lower than 156 +/- 5/94 +/- 2 in group II (p less than 0.05). At entry into the clinic and at the last visit, dosing and type of medications were similar in both groups. Although patient visits averaged 6.7/yr in both groups, patients in group II missed 1.7 +/- 0.3 compared with 0.9 +/- 0.1 visits/year for group I (p less than 0.01). Group II patients were also less compliant with medications, primarily because of psychosocial problems. Medications, however, were more available to this group, since 16 of 19 (84%) were Medicaid recipients, compared with 46 of 86 (53%) in group I (p less than 0.025).(ABSTRACT TRUNCATED AT 250 WORDS)