Implications of a health lifestyle and medication analysis for improving hypertension control

Background: National Health and Nutritional Examination surveys have docume nted poor rates of hypertension treatment and control, leading to preventab le morbidity and mortality. Objectives: To examine covariation in the medication and health lifestyle b eliefs and behaviors of persons with hypertension to identify and profile d istinct subgroups of patients. Methods: A sample of 727 patients with hypertension, weighted to match the 1992 National Health interview Survey age and sex distribution of patients with hypertension, was interviewed by telephone about their beliefs and beh aviors regarding hypertension and its management. Cluster analysis of key v ariables was used to identify 4 patient types. Results: Subgroups differed significantly. Group A members use an effective mix of medication and health lifestyle regimens to control blood pressure. Group B members are most likely to depend on medication and have high adhe rence rates. Yet they also have high rates of smoking (29%) and alcohol use (average, 104 times per year) and are less likely to exercise regularly. G roup C members are most likely to forget to take medication, are likely to be obese, and find it most difficult to comply with lifestyle changes (exce pt for very low rates of smoking and alcohol use). Group D members are leas t likely to take medication, most likely to change or stop medication witho ut consulting their physician (20%), most likely to smoke (40%), and least likely to control diet (29%). Group A and B members have better health outc omes than group C and D members. Conclusions: Optimal management strategies are likely to differ for the 4 p atient types. Further research should be conducted to validate these findin gs on a separate sample and to devise and test tailored management algorith ms for hypertension compliance and control.