Which standard for blood pressure control? WHO or JNC-VI?

Abstract

Given the detrimental effects of uncontrolled hypertension, particularly in high risk patients, the objectives were to assess the prevalence of cardiovascular (CV) risk factors within the hypertensive (HTN) population and to compare the proportion of HTN patients with controlled blood pressure (BP) based on guidelines from the Joint National Committee on Hypertension (JNC-VI) and the more stringent World Health Organization-International Society of Hypertension Guidelines (WHO). JNC-VI defines BP control as <140/90 for non-diabetic patients and <130/85 for diabetic patients, whereas WHO has stated “it would seem desirable to achieve optimal or normal blood pressures (<130/85) in young, middle-aged or diabetic subjects,” and <140/90 in the elderly. HTN patients age 18 and over from Hill Physicians Medical Group, Inc. were identified from 1999 pharmacy and medical claims data. A total of 47,282 patients were identified, accounting for approximately 13% of the total population. Patients were then randomly selected from this population for chart review (Group 1: hypertension, with or without diabetes). Additionally, patients were randomly selected from the diabetic subpopulation (Group 2: hypertension and diabetes). The researchers documented the patients' BP, presence of any CV risk factors and target organ damage, side effects and antihypertensive therapy. Over 85% of patients in Group 1 (N= 350) had two or more CV risk factors in addition to HTN, while over 98% of patients in Group 2 (N= 170) had two or more. When assessing the overall population (Groups 1 and 2), only 2% had no documented risk factors or target organ damage. According to JNC-VI, the level of BP control was 38.6% (n=135) and 20.0% (n=34) for Groups 1 and 2, respectively. When applying the WHO criteria for control, 30.9% of patients (n=108) in Group 1 and 20% of patients (n=34) in Group 2 were controlled. See table for differences in Group 1 control by age. Given the high prevalence of risk factors, it is critical that physicians treat patients aggressively in order to reduce the higher risk of mortality. The advantages and disadvantages of each guideline will be presented within the context of the Hill Physicians' data.