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Blood pressure control among Veterans with high cardiovascular disease risk
Aseel Zghayer1, Meghan O'Halloran2, Kevin Stroupe3,4
1Departments of Medicine, Loyola University Chicago, Chicago, IL, USA.
Insights
Less than half of U.S. Veterans with hypertension achieved optimal blood pressure (BP) control (<130/80 mmHg), despite high cardiovascular disease (CVD) risk. Strategies like team-based care and home BP monitoring are needed to improve hypertension management in Veterans.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Cardiovascular disease (CVD) is a leading cause of mortality and disability among U.S. Veterans.
- Effective blood pressure (BP) control is crucial for reducing CVD risk.
- Hypertension management is a key focus within Veterans Affairs (VA) healthcare.
Purpose of the Study:
- To examine BP control rates in U.S. Veterans with hypertension at high risk for CVD events.
- To define BP control as systolic BP < 130 mmHg and diastolic BP < 80 mmHg.
- To identify BP control levels across different risk subgroups within the Veteran population.
Main Methods:
- Utilized VA Informatics and Computing Infrastructure Corporate Data Warehouse data.
- Included primary care visits from January 2019 to February 2020 for Veterans with hypertension.
- Focused on Veterans aged ≥65 years and/or with diagnoses of CVD, diabetes mellitus (DM), or chronic kidney disease (CKD).
Main Results:
- The study included 83,633 Veterans with hypertension (mean age 71.6 years, 96.4% male).
- Overall BP control < 130/80 mmHg was achieved in 38.7% of Veterans.
- BP control < 140/90 mmHg was achieved in 76.9% of Veterans, with higher rates in subgroups with CVD, DM, or CKD.
Conclusions:
- Less than half of high-risk Veterans with hypertension achieved the target BP of < 130/80 mmHg.
- Improved BP control strategies are necessary, including team-based care and home BP monitoring.
- Further research should explore enhanced hypertension management approaches within the VA system.
Objective:
Blood pressure (BP) control reduces risk of cardiovascular disease (CVD), the major cause of disability and mortality among the nine million U.S. Veterans receiving care in Veterans Affairs (VA) medical centers. This study examined BP control, defined as a systolic BP < 130 mmHg and diastolic BP < 80 mmHg, among U.S. Veterans with hypertension at high risk for primary or secondary CVD events.
Methods:
We utilized data from the VA Informatics and Computing Infrastructure Corporate Data Warehouse on primary care visits within the eight Great Lakes VA medical centers for Veterans with at least one visit between January 1, 2019, and February 28, 2020 and a documented visit within the 12 months prior to study initiation date. Analyses focused on Veterans with diagnosed hypertension and one or more of the following: age ≥65 years, and/or diagnosis of CVD, diabetes mellitus (DM) or chronic kidney disease (CKD). BP control was based on the last recorded BP measurement during the study period.
Results:
The mean age of 83,633 Veterans with hypertension was 71.6 years (10.4) years, 96.4 % were male and race/ethnicity was reported as non-Hispanic White in 74.8 %, non-Hispanic Black or African American in 18.4 %, non-Hispanic Asian in 0.3 %, Alaskan Indian or Pacific Islander in 2.6 % and Hispanic in 2.5 %. Mean SBP and DBP based on vital signs at the last clinic visit were 130.8 mmHg (standard deviation [SD] 11.6) and 73.7 mmHg (SD 8.8), respectively. Overall, BP was controlled to < 130/80 mmHg in 38.7 % (95 % Confidence Interval [CI] 38.4, 39.1) and <140/90 mmHg in 76.9 % (95 % CI 76.7, 77.2). Among subgroups, BP was controlled to < 130/80 mmHg in 39.8 % (95 % CI 39.4, 40.2) of the Veterans aged ≥65 years, 45.3 % (95 % CI 44.7, 45.9) with CVD, 39.8 % (95 % CI 39.2, 40.3) with DM, 42.8 % (95 % CI 41.9, 43.6) with CKD and 47.1 % (95 % CI 45.5, 48.6) with CVD +DM +CKD. In contrast, BP control <140/90 mmHg was noted in over 75 % of Veterans within all subgroups.
Conclusion:
In this group of Veterans with hypertension and high risk for CVD events, less than half had BP controlled to < 130/80 mmHg. Future studies should investigate strategies to improve BP control such as team-based care with home BP monitoring, education of clinicians on hypertension management, and increased utilization of automated office BP.
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Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.