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National patterns in intensity and frequency of outpatient care for apparent treatment-resistant hypertension

Sreekanth Vemulapalli1, Luqin Deng2, Manesh R Patel1

  • 1Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.

American Heart Journal
|April 30, 2017
PubMed

Insights

Many older adults with apparent treatment-resistant hypertension (aTRH) do not receive frequent care. This study highlights a need for increased medical attention for these high-risk hypertension patients to improve cardiovascular outcomes.

Area of Science:

  • Cardiology
  • Geriatrics
  • Public Health

Background:

  • Apparent treatment-resistant hypertension (aTRH) is linked to worse cardiovascular outcomes.
  • Understanding care patterns for aTRH in older adults is crucial for improving health.
  • The REGARDS study and Medicare claims data provide a robust dataset for this analysis.

Purpose of the Study:

  • To determine the frequency and intensity of medical care received by older adults with aTRH.
  • To compare care patterns between patients with uncontrolled aTRH (UaTRH), controlled aTRH (CaTRH), and no aTRH.
  • To identify factors influencing the level of care for patients with UaTRH.

Main Methods:

  • Defined aTRH based on antihypertensive medication use and blood pressure control (UaTRH and CaTRH).
  • Analyzed data from 4650 hypertensive participants aged 65+ in the REGARDS study linked with Medicare claims.
  • Compared hypertension-related visit frequency and diagnostic intensity across aTRH categories.

Main Results:

  • 10.1% had UaTRH and 5.3% had CaTRH; 84.6% had hypertension without aTRH.
  • Patients with UaTRH had more frequent primary care and cardiology visits than those without aTRH.
  • However, many with UaTRH (26.5%) had only one hypertension-related visit annually, with males, whites, and smokers less likely to have >1 visit.

Conclusions:

  • A significant proportion of older adults with UaTRH do not receive adequate hypertension care, with less than annual follow-up.
  • These findings suggest a need to enhance care frequency and intensity for patients with UaTRH.
  • Targeted interventions may be necessary to ensure optimal management and reduce cardiovascular risk in this population.
Abstract

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