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A large cohort study evaluating risk factors associated with uncontrolled hypertension

Dina T Elperin1, Mitchell A Pelter, Robert L Deamer

  • 1Kaiser Permanente Woodland Hills Medical Center, Woodland Hills, CA.

Journal of Clinical Hypertension (Greenwich, Conn.)
|March 5, 2014
PubMed

Insights

Uncontrolled hypertension is linked to higher risks of heart disease and stroke. African Americans, unpartnered individuals, and those with poor medication adherence face increased odds of uncontrolled blood pressure.

Area of Science:

  • Cardiovascular Medicine
  • Public Health
  • Epidemiology

Background:

  • Hypertension is a prevalent condition in the U.S., with uncontrolled cases significantly elevating risks for myocardial infarction, heart failure, stroke, and kidney disease.
  • Effective management of hypertension is crucial for preventing severe long-term health consequences and reducing healthcare burdens.

Purpose of the Study:

  • To identify patient characteristics associated with uncontrolled hypertension within a large, integrated healthcare system.
  • To inform the development of targeted hypertension management strategies.

Main Methods:

  • A retrospective cohort study involving 661,075 patients with uncontrolled hypertension (Systolic Blood Pressure ≥ 140 mm Hg and/or Diastolic Blood Pressure ≥ 90 mm Hg).
  • Multivariate analysis was employed to assess associations between patient demographics, medication data, and uncontrolled hypertension.
  • A secondary analysis explored the correlation between uncontrolled blood pressure and Patient Health Questionnaire-9 (PHQ-9) scores.

Main Results:

  • African Americans (OR, 1.18; 95% CI, 1.16-1.20) and unpartnered populations (OR, 1.15; 95% CI, 1.14-1.17) showed significant associations with uncontrolled hypertension compared to Caucasians.
  • A higher number of prescribed antihypertensive medications (OR, 1.37; 95% CI, 1.33-1.41) and adherence to most medications were also associated with uncontrolled blood pressure.
  • An association was found between uncontrolled blood pressure and higher Patient Health Questionnaire-9 (PHQ-9) scores (OR, 1.21; 95% CI, 1.16-1.26).

Conclusions:

  • Identified risk factors, including race, social support, medication adherence, and mental health indicators, necessitate aggressive hypertension management.
  • Implementing targeted interventions for high-risk populations is essential for preventing cardiovascular disease stemming from uncontrolled hypertension.

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