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

Abstract

An aggressive strategy to manage hypertension in a large integrated healthcare organization achieved blood pressure control in 82% of hypertensive patients, as compared with 52% nationwide. It is unknown why the remaining 18% is uncontrolled. The objective of this study was to identify characteristics associated with patients whose blood pressure remains continuously uncontrolled. This nested case-control study included 1583 continuously uncontrolled cases and 7901 matched controls. Univariate analysis revealed patients who visited their primary care provider frequently (odds ratio, 0.42; 95% confidence interval, 0.39-0.46) were adherent to antihypertensive medications (odds ratio, 0.12; 95% confidence interval, 0.10-0.14), and dispensed more medications (odds ratio, 0.86; 95% confidence interval, 0.85-0.87) were less likely to be continuously uncontrolled. Patient characteristics that were associated with continuously uncontrolled hypertension were the Patient Health Questionnaire-9 score and higher body mass index. Since patients with controlled hypertension visited their provider more often, patients with continuously uncontrolled hypertension may benefit from more interaction with their healthcare system.

Figure 1

Patient population. HTN indicates hypertension; EMR, electronic medical record.

Figure 2

Forest plot of antihypertensive medication dispensed. OR indicates odds ratio; CI, confidence interval; CCB, calcium channel blocker; ACEi, angiotensin‐converting enzyme inhibitor; ARB, angiotensin receptor blocker; DHP, dihydropyridine; HTN, hypertension.

Figure 3

Forest plot of medication adherence (proportion of days covered ≥80%). OR indicates odds ratio; CI, confidence interval; CCB, calcium channel blocker; ACEi, angiotensin‐converting enzyme inhibitor; ARB, angiotensin receptor blocker; DHP, dihydropyridine; HTN, hypertension.

Figure 4

Forest plot of patient characteristics. PDC indicates proportion of days covered; OR, odds ratio; CI, confidence interval; CCB, calcium channel blocker; ACEi, angiotensin‐converting enzyme inhibitor; ARB, angiotensin receptor blocker; DHP, dihydropyridine; HTN, hypertension.

Figure 5

Forest plot of comorbidities. PDC indicates proportion of days covered; OR, odds ratio; CI, confidence interval; CCB, calcium channel blocker; ACEi, angiotensin‐converting enzyme inhibitor; ARB, angiotensin receptor blocker; DHP, dihydropyridine; HTN, hypertension.