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Blood Pressure Control and Factors Predicting Control in a Treatment‐Compliant Male Veteran Population
Author(s) -
Bizien Marcel D.,
Jue Sandra G.,
Panning Chad,
Cusack Barry,
Peterson Teri
Publication year - 2004
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1592/phco.24.2.179.33136
Subject(s) - medicine , blood pressure , odds ratio , population , angina , coronary artery disease , stroke (engine) , confidence interval , veterans affairs , cardiology , myocardial infarction , mechanical engineering , environmental health , engineering
Study Objective. To estimate blood pressure control and identify treatment variables predicting control in treatment‐compliant, hypertensive, male veterans. Setting. Outpatient clinic of a Veterans Affairs medical center. Design. Retrospective review of computerized patient records over a 12‐month period for demographics, comorbidities, patient‐specific blood pressure goals, blood pressure history, antihypertensive therapy, and refill history. Patients. Two hundred fifty hypertensive men aged 39–90 years whose antihypertensive regimen remained unchanged over 12 months. Measurements and Main Results. The proportion of patients with blood pressures below 160/90 mm Hg was 86%; only 34.8% had pressures below 140/90 mm Hg. Blood pressure control was less common with advancing age (42.1%, 33.7%, and 29.4% for patients aged < 60, 60–75, and > 75 yrs, respectively, p=0.057 for trend). Treatment intensity was highest in obese men, those aged 60–75 years, and those with a history of chronic heart failure or angina, and lowest in men older than 75 years or with a history of stroke. Blood pressure control was independently associated with therapy with β‐blockers (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.5–10.2, p=0.005), loop diuretics (OR 4.3, 95% CI 1.6–12.1, p=0.005), angiotensin‐converting enzyme inhibitors (OR 3.1, 95% CI 1.2–8.2, p=0.025), and long‐term simvastatin therapy (OR 3.7, 95% CI 1.9–7.4, p=0.0001), and with a diagnosis of coronary artery disease (OR 3.2, 95% CI 1.35–7.69, p=0.009). The relationship between simvastatin therapy and blood pressure control persisted after controlling for the higher treatment intensity in patients taking the drug. Factors predicting poor control included a history of stroke (OR for control 0.36, 95% CI 0.19–0.69, p=0.002), age over 75 years (OR 0.43, 95% CI 0.18–0.98, p=0.046), highest low‐density lipoprotein tertile (OR 0.37, 95% CI 0.17–0.80, p=0.013), highest body mass index tertile (OR 0.46, 95% CI 0.21–1.00, p=0.05), and therapy with two or fewer antihypertensives (OR 0.14, 95% CI 0.04–0.61, p=0.009). Conclusion. In a compliant veteran population, control of blood pressure appeared inadequate but was significantly more likely in those receiving at least three antihypertensive agents. Long‐term therapy with simvastatin was independently associated with increased odds of control.