Treatment of hypertension in a managed care setting

Background: Based on recommendations of the Fifth and Sixth Reports of the Joint National Committee (INC) on Prevention, Detection, Evaluation, and Tr eatment of High Blood Pressure, Health Care Plan (now Univera Healthcare) B uffalo, NY, developed a clinical guideline to improve the management of pat ients with hypertension. To increase awareness and utilization, the guideli ne was distributed as hard copy reports and made available through our elec tronic information system. Objective: To determine blood pressure (BP) control rates and adherence to guideline recommendations. Study Design: Retrospective chart review. Patients and Methods: We randomly sampled hypertensive patients seen during 1998 to evaluate hypertension management. Computerized medical and pharmac y records were reviewed for patient demographics, antihypertensive medicati ons, comorbid conditions, and BP readings. Patient assessment was based on antihypertensive regimen and achievement: of target BP according to the rec ommendations of the guideline (< 140/90 mm Hg for the general population an d < 130/85 mm Hg for special populations). In addition, we assessed control rates using traditional Health Plan Employer Data and Information Set (HED IS) measures (< 140/90 mm Hg). Results: Overall, 35% of patients achieved target BP and 68% were treated w ith agents recommended by our JNC-based guideline, in contrast, using tradi tional HEDIS measures, 41% of patients achieved BP control. Of 39 patients with compelling indications (primarily diabetic patients), 13% achieved BP target and 67% were treated with recommended agents. Conclusions: The impact of our clinical guideline is reflected through the relatively high utilization of recommended drugs. However, optimal BP contr ol continues to be problematic. In particular, patients with diabetes warra nt focused attention.