Identification and evaluation of risk factors in patients with continuously uncontrolled hypertension

Area of Science:

• Cardiovascular Medicine
• Health Services Research
• Clinical Hypertension Management

Background:

• An aggressive hypertension management strategy in a large integrated healthcare organization achieved 82% blood pressure control, significantly higher than the 52% national average.
• The reasons for uncontrolled hypertension in the remaining 18% of patients within this system were previously unknown.

Purpose of the Study:

• To identify patient characteristics associated with continuously uncontrolled hypertension.
• To understand factors contributing to treatment resistance in a high-performing hypertension management program.

Main Methods:

• A nested case-control study design was employed.
• Included 1583 continuously uncontrolled hypertension cases and 7901 matched controls.
• Univariate analysis examined associations between patient characteristics and uncontrolled hypertension.

Main Results:

• Frequent primary care provider visits (OR, 0.42) and medication adherence (OR, 0.12) were associated with lower odds of uncontrolled hypertension.
• Dispensing of more antihypertensive medications (OR, 0.86) also correlated with better control.
• Higher Patient Health Questionnaire-9 scores and increased body mass index were linked to continuously uncontrolled hypertension.

Conclusions:

• Patients with uncontrolled hypertension may benefit from increased healthcare system interaction, mirroring patterns seen in controlled patients.
• Identifying specific patient characteristics like mental health status and BMI is crucial for targeted interventions.
• Further research should explore enhanced patient engagement strategies for refractory hypertension cases.