Effect of cardiometabolic risk factors on hypertension management: a cross-sectional study among 28 physician practices in the United States

<p>Abstract</p> <p>Objective</p> <p>This cross-sectional study sought to determine the prevalence of cardiometabolic risk factor clusters (CMRFCs) and their effect on BP control among hypertensive patients from 28 US physician practices.</p> <p>Methods</p> <p>Each participating practice identified a random sample of 150-300 adults aged ≥ 18 years diagnosed with hypertension. The primary outcome variable was BP control (BP < 140/90 mmHg for non-diabetic and <130/80 mmHg for diabetic patients). CMRFCs included hypertension in addition to obesity, dyslipidemia, and diabetes.</p> <p>Results</p> <p>Overall, 6,527 hypertensive patients were identified for study inclusion. More than half (54.3%) were female, and mean age was 64.7 years. Almost half (48.7%) were obese (BMI ≥ 30 kg/m²). About 1 in every 4 patients (25.3%) had diabetes, and 60.7% had dyslipidemia. Mean blood pressure was 132.5/77.9 mmHg, and 55.0% of all patients had controlled BP; 62.4% of non-diabetic patients, and 33.3% of diabetic hypertensive patients, had BP controlled to recommended levels. Most (81.7%) hypertensive patients had ≥ 1 cardiometabolic risk factor, and 12.2% had all 3 risk factors. As compared to hypertensive patients without additional risk factors, adjusted odds ratios for BP control were significantly lower for all combinations of CMRFCs (ORs 0.15-0.83, all p < 0.04), with the exception of patients who had only dyslipidemia in addition to hypertension (OR = 1.09, p = NS). Prescriber adherence to recommended hypertension treatment guidelines for patients with diabetes, heart failure, or prior myocardial infarction was high. Although patients with risk factors were prescribed more antihypertensive medications than those without, hypertensive patients with all 3 risk factors were prescribed a mean of 2.4 antihypertensive medications compared to 1.7 for those with no risk factors; odds of BP control in these patients, however, was 0.23 [95% CI 0.19-0.29] that of patients with no other CMRFCs.</p> <p>Conclusions</p> <p>Across 28 US practices, only 18% of hypertensive patients did not have any additional cardiometabolic risk factors. The high prevalence of CMRFCs presents a challenge to effective hypertension management.</p

Effect of African American race on hypertension management: a real-world observational study among 28 US physician practices.

OBJECTIVE: To assess the impact of African American race on hypertension management among a real-world hypertensive population. DESIGN: Cross-sectional study. SETTING: 28 US physician practices. PATIENTS: Adult patients with a hypertension diagnosis between November 2006 and September 2008. MAIN OUTCOME MEASURES: Blood pressure (BP) control (< 140/90 mm Hg for non-diabetic, and < 130/80 mm Hg for diabetic, patients). RESULTS: African American patients (n = 1,079) were younger than Caucasian patients (n = 3,884) (60.2 vs 66.0 years, P < .01), were more likely to be female (60.1% vs 52.5%, P < .01), were more likely to be obese (55.9% vs 48.5%, P < .01) and had a higher diabetes prevalence (29.4% vs 23.8%, P < .01). African American hypertensive patients had significantly higher BP as compared to Caucasian hypertensive patients (135.2/82.9 mm Hg vs 130.5/76.4 mm Hg, P < .01). Both diabetic and non-diabetic African Americans were prescribed more antihypertensive medications than Caucasians and were more likely to be prescribed combination regimens. African Americans were less likely to be prescribed beta blockers, and more likely to be prescribed calcium channel blockers or diuretics. Among non-diabetic and diabetic patients, African Americans had 54% and 53% lower adjusted odds, respectively, of controlled BP. The use of specific antihypertensive medication classes was not associated with BP control. CONCLUSIONS: Although African Americans were prescribed more aggressive medication regimens, they had lower probability of BP control. While African American race influenced the choice of prescribed antihypertensive medications, those regimens did not affect the probability of BP control. African American race should not deter providers from prescribing specific antihypertensive medication classes, particularly in the presence of compelling indications