Management of Hypertension in Primary Care Safety‐Net Clinics in the United States: A Comparison of Community Health Centers and Private Physicians' Offices

Objective To examine adherence to guideline‐concordant hypertension treatment practices at community health centers ( CHC s) compared with private physicians' offices. Data Sources/Study Setting National Ambulatory Medical Care Survey from 2006 to 2010. Study Design We examined four guideline‐concordant treatment practices: initiation of a new medication for uncontrolled hypertension, use of fixed‐dose combination drugs for patients on multiple antihypertensive medications, use of thiazide diuretics among patients with uncontrolled hypertension on ≥3 antihypertensive medications, and use of aldosterone antagonist for resistant hypertension, comparing use at CHC with private physicians' offices overall and by payer group. Data Collection/Extraction Methods We identified visits of nonpregnant adults with hypertension at CHC s and private physicians' offices. Principal Findings Medicaid patients at CHC s were as likely as privately insured individuals to receive a new medication for uncontrolled hypertension ( AOR 1.0, 95 percent CI : 0.6–1.9), whereas Medicaid patients at private physicians' offices were less likely to receive a new medication ( AOR 0.3, 95 percent CI : 0.1–0.6). Use of fixed‐dose combination drugs was lower at CHC s ( AOR 0.6, 95 percent CI : 0.4–0.9). Thiazide use for patients was similar in both settings ( AOR 0.8, 95 percent CI : 0.4–1.7). Use of aldosterone antagonists was too rare (2.1 percent at CHC s and 1.5 percent at private clinics) to allow for statistically reliable comparisons. Conclusions Increasing physician use of fixed‐dose combination drugs may be particularly helpful in improving hypertension control at CHC s where there are higher rates of uncontrolled hypertension.