Correlates of Controlled Hypertension in Indigent, Inner-City Hypertensive Patients

Authors

  • Jasjit S. Ahluwalia MD, MPH, MS,

    1. Department of Medicine, Emory University School of Medicine, Rollins School of Public Health, Atlanta, Ga.
    2. Department of Health Policy and Management, Rollins School of Public Health, Atlanta, Ga.
    Search for more papers by this author
  • Sally E. McNagny MD, MPH,

    1. Department of Medicine, Emory University School of Medicine, Rollins School of Public Health, Atlanta, Ga.
    2. Department of Epidemiology, Rollins School of Public Health, Atlanta, Ga.
    Search for more papers by this author
  • Kimberly J. Rask MD, PhD

    1. Department of Medicine, Emory University School of Medicine, Rollins School of Public Health, Atlanta, Ga.
    2. Department of Health Policy and Management, Rollins School of Public Health, Atlanta, Ga.
    Search for more papers by this author

Dr.Ahluwalia : Emory University School of Medicine, 69 Butler St., Atlanta, GA 30303.

Abstract

OBJECTIVE:

To identify correlates of controlled hypertension in a largely minority population of treated hypertensive patients.

DESIGN:

Case-control study.

SETTING:

Urban, public hospital.

PATIENTS:

A consecutive sample of patients who were aware of their diagnosis of hypertension for at least 1 month and had previously filled an antihypertensive prescription. Control patients had a systolic blood pressure (SBP) ≤ 140 mm Hg and diastolic blood pressure (DBP) ≤ 90 mm Hg, and case patients had a SBP ≥ 180 mm Hg or DBP ≥ 110 mm Hg.

MEASUREMENTS AND MAIN RESULTS:

Control subjects had a mean blood pressure (BP) of 130/80 mm Hg and case subjects had a mean BP of 193/106 mm Hg. Baseline demographic characteristics between the 88 case and the 133 control subjects were not significantly different. In a logistic regression model, after adjusting for age, gender, race, education, owning a telephone, and family income, controlled hypertension was associated with having a regular source of care (odds ratio [OR] 7.93; 95% confidence interval [CI] 3.86, 16.29), having been to a doctor in the previous 6 months (OR 4.81; 1.14, 20.31), reporting that cost was not a deterrent to buying their antihypertensive medication (OR 3.63; 1.59, 8.28), and having insurance (OR 2.15; 1.02, 4.52). Being compliant with antihypertensive medication regimens was of borderline significance (OR 1.96; 0.99, 3.88). A secondary analysis found that patients with Medicaid coverage were significantly less likely than the uninsured to report cost as a barrier to purchasing antihypertensive medications and seeing a physician.

CONCLUSIONS:

The absence of out-of-pocket expenditures under Medicaid for medications and physician care may contribute significantly to BP control. Improved access to a regular source of care and increased sensitivity to medication costs for all patients may lead to improved BP control in an indigent, inner-city population.

Ancillary