C-B1-02: Strategies Used by Physicians to Treat Hypertension

Abstract

Background and Aims: There is high variation in the way hypertension is managed by primary care physicians (PCP’s). The aim of this study was to evaluate correlations between the frequency of different treatment strategies and overall achievement of blood pressure goals. Methods: We reviewed 280,423 encounters with 127 HealthPartners PCP’s totaling 57,101 patients with hypertension. Encounters occurred from 1/2/07 to 5/29//09. For each encounter, data included blood pressure, blood pressure drugs in the classes ACE, ARB, Diuretic, Beta Blocker, Alpha Blocker and Calcium Channel Blocker, and the presence of the co-morbid conditions of diabetes, chronic kidney disease (CKD) and heart disease. The dependent variable was the proportion of a physician’s encounters with blood pressure at goal. Independent variables included start of a new BP medication, increased dose of a pre-existing BP medication, visit interval (time to next encounter), and comorbid conditions. Patients were considered at goal if both the diastolic and systolic blood pressure met the recommended criteria. Results: Of the encounters, 31% were not at goal. Of these patient with encounters not at goal, 15.5% were started on a new class of BP medication and a higher use of this strategy correlated with a higher overall proportion of encounters at BP goal (r=.51; p<0.0001). At 14.9% of the encounters there was an upward adjustment of the dosage of a medication and a use of this strategy also correlated with overall proportion of patient encounters with BP at goal (r=.43; p<0.0001). The average encounter interval was significant (r=.21; p=0.0215) only for patients with stage 2 hypertension. The comorbid conditions of diabetes (r=.38; p<0.0001) and kidney disease (r=.21; p=0.0171 were both related to less success at achieving BP goals. Conclusions: Physicians who were more likely to start new classes of medications or upwardly titrate BP drugs at encounters had a higher proportion of their patient encounters at recommended blood pressure goals. Shorter visit interval was also beneficial in patients with stage 2 hypertension (greater than 20/10 over goal). Not surprisingly, physicians had more difficulty achieving blood pressure goals in patients with diabetes and kidney disease.