Hypertension control in multi-ethnic primary care clinics

Area of Science:

• Cardiology
• Public Health
• Primary Care Medicine

Background:

• The JNC-V guidelines recommend blood pressure (BP) control to <140/90 mm Hg, emphasizing systolic pressure.
• Hypertension management in diverse, low-income populations presents unique challenges.

Purpose of the Study:

• To assess BP control extent and determinants in a large, multi-ethnic, low-income hypertensive population prior to JNC-V guideline implementation.
• To identify factors associated with uncontrolled hypertension in this cohort.

Main Methods:

• Retrospective review of 2925 patient records from nine primary care clinics.
• Analysis of demographics, baseline BP, 12-month average BP, and prescribed antihypertensives.
• Logistic regression to identify determinants of BP control.

Main Results:

• Overall, 46% of patients achieved <140/90 mm Hg; 49% had systolic BP <140 mm Hg and 79.5% had diastolic BP <90 mm Hg.
• Age, baseline BP, BMI, and ethnicity were associated with BP control.
• Hispanics (OR=2.05) and Black individuals (OR=1.48) were more likely to have uncontrolled hypertension compared to whites.
• 12% received no medication; 52% of those on medication were on monotherapy, with 45% having uncontrolled systolic BP.

Conclusions:

• Current BP control rates, particularly systolic, fall short of JNC-V targets in this population.
• Aggressive antihypertensive medication titration and provider education are needed to improve systolic BP control.
• Addressing ethnic disparities in hypertension management is crucial.