Multiple uncontrolled conditions and blood pressure medication intensification: an observational study

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Amanda H Salanitro1, Ellen Funkhouser, Bonita S Agee

  • 1VA National Quality Scholars Program, Department of Veterans Affairs Medical Center, Birmingham, AL, USA. asalan@uab.edu.

Implementation Science : IS
|July 21, 2010
PubMed

Insights

Uncontrolled diabetes and hyperlipidemia were associated with increased blood pressure (BP) medication intensification in hypertensive patients. However, controlled conditions led to lower intensification rates, indicating a need for improved care strategies.

Area of Science:

  • Cardiology
  • Primary Care
  • Clinical Decision Making

Background:

  • Multiple uncontrolled medical conditions can complicate clinical decision-making.
  • This study hypothesized that uncontrolled cardiovascular risk factors would reduce blood pressure (BP) medication intensification in hypertensive patients.

Purpose of the Study:

  • To investigate the association between uncontrolled diabetes and hyperlipidemia and BP medication intensification.
  • To examine how the control status of these comorbidities affects hypertension management.

Main Methods:

  • Observational study of 946 encounters at two VA primary care clinics.
  • BP medication intensification recorded post-encounter; demographic, clinical, and lab data collected.
  • Hierarchical regression models used to analyze BP medication intensification based on diabetes and hyperlipidemia control status.

Main Results:

  • Among 387 uncontrolled hypertensive patients, 51.4% had diabetes (25.3% uncontrolled) and 73.4% had hyperlipidemia (22.7% uncontrolled).
  • BP medication intensification was 34.9% overall, but higher (52.8%) with uncontrolled diabetes/hyperlipidemia, and even higher (70.6%) if systolic BP was significantly above goal.
  • Intensification rates were lowest when diabetes or hyperlipidemia were controlled.

Conclusions:

  • Uncontrolled diabetes and hyperlipidemia correlate with more guideline-concordant hypertension care, especially when BP is far from goal.
  • Further research is needed to understand and enhance BP medication intensification in patients with controlled diabetes and/or hyperlipidemia.
Abstract

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