HYPERTENSION CONTROL IN MULTIETHNIC PRIMARY-CARE CLINICS

The most recent JNC-V guidelines for hypertension treatment call for c ontrol of blood pressure (BP) to <140/90 mm Hg, with increased emphasi s on control of systolic pressure. To determine the extent and determi nants of BP control in a large multi-ethnic, low-income clinic populat ion of diagnosed hypertensives immediately prior to issuance of the ne w guidelines, we reviewed the medical records of 2925 patients sampled from a population of over 14 000 hypertensives following in a network of nine primary care clinics operated by the Harris County Hospital D istrict in Houston, Texas. Variables extracted from the medical record included: systolic (SEP) and diastolic (DBP) blood pressure at the in itial clinic visit, average of all BP readings in the 12 months prior to the chart review (the measure of current control), antihypertensive s prescribed at the most recent visit, and patient sociodemographic va riables. The mean age of the sample was 61.6 +/- 12.8 years, and 67% w ere female. Average 12-month SEP and DBP were 141 +/- 14.7 and 83.6 +/ - 8.5 respectively. Forty-nine per cent of patients had SEP controlled to <140 mm Hg, 79.5% had DBP controlled to <90 mm Hg, and 46% of pati ents achieved the criterion of <140/90 mm Hg. In logistic regression a nalysis, age, baseline BP, body mass index and ethnicity, but not gend er, were associated with current control. After adjustment for other c ovariates, Hispanics and Black people were significantly more likely t o be in poor control than whites (OR(Hisp) = 2.05, 95% Cl = 1.57-2.70; OR(Black) = 1.48, 95% Cl = 1.21-1.81). Twelve per cent of patients we re not receiving any antihypertensive medication. Of the remaining, th e majority (52%) were on monotherapy. In the monotherapy group, 45% ha d SEP greater than or equal to 140 mm Hg and 16% had DBP greater than or equal to 90 mm Hg. We conclude that the achievement of new treatmen t recommendations will require education of primary care providers in more aggressive titration of antihypertensive medications to control S EP.