Understanding Uncontrolled Hypertension: Is It the Patient or the Provider?

Authors

  • Adam J. Rose MD, MSc,

    1. From the Center for Health Quality, Outcomes, and Economic Research (a VA Health Services Research and Development National Center of Excellence), Bedford VA Medical Center, Bedford, MA;1the Department of Medicine, Section of General Internal Medicine, Boston University School of Medicine, Boston, MA;2 and the Department of Health Policy and Management, Boston University School of Public Health, Boston, MA3
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  • 1,2 Dan R. Berlowitz MD, MPH,

    1. From the Center for Health Quality, Outcomes, and Economic Research (a VA Health Services Research and Development National Center of Excellence), Bedford VA Medical Center, Bedford, MA;1the Department of Medicine, Section of General Internal Medicine, Boston University School of Medicine, Boston, MA;2 and the Department of Health Policy and Management, Boston University School of Public Health, Boston, MA3
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  • 1,2,3 Michelle B. Orner MPH,

    1. From the Center for Health Quality, Outcomes, and Economic Research (a VA Health Services Research and Development National Center of Excellence), Bedford VA Medical Center, Bedford, MA;1the Department of Medicine, Section of General Internal Medicine, Boston University School of Medicine, Boston, MA;2 and the Department of Health Policy and Management, Boston University School of Public Health, Boston, MA3
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  • and 1 Nancy R. Kressin PhD 1,2

    1. From the Center for Health Quality, Outcomes, and Economic Research (a VA Health Services Research and Development National Center of Excellence), Bedford VA Medical Center, Bedford, MA;1the Department of Medicine, Section of General Internal Medicine, Boston University School of Medicine, Boston, MA;2 and the Department of Health Policy and Management, Boston University School of Public Health, Boston, MA3
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Adam J. Rose, MD, MSc, Center for Health Quality, Outcomes, and Economic Research, 200 Springs Road, Building 70, Bedford, MA 01730
E-mail: adamrose@bu.edu

Abstract

The relative contributions of adherence and treatment intensity to blood pressure (BP) control are not well understood. The authors studied patients with uncontrolled hypertension (N=410) from 3 primary care clinics in the Veterans Affairs (VA) medical system. A questionnaire was used to assess patient adherence to therapy, and VA system pharmacy fills were used to assess the intensity of the antihypertensive regimen. At baseline, an inadequate antihypertensive regimen was implicated as the most probable reason for uncontrolled BP in a majority of patients (72%), while nonadherence could only be implicated in 13%. In multivariate longitudinal analyses, patients who had an increase in their medical treatment during the study had lower final diastolic BP levels compared with the patients who did not (−3.70 mm Hg; P<.05). While patient adherence to therapy plays a role, vigorous clinical management by the clinician is a more important contributor to BP control.

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