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dc.contributor.authorBerlowitz, Dan R.
dc.contributor.authorAsh, Arlene S.
dc.contributor.authorHickey, Elaine C.
dc.contributor.authorFriedman, Robert H.
dc.contributor.authorGlickman, Mark
dc.contributor.authorKader, Boris
dc.contributor.authorMoskowitz, Mark A.
dc.date2022-08-11T08:10:42.000
dc.date.accessioned2022-08-23T17:17:04Z
dc.date.available2022-08-23T17:17:04Z
dc.date.issued1998-12-31
dc.date.submitted2010-07-01
dc.identifier.citationN Engl J Med. 1998 Dec 31;339(27):1957-63. <a href="http://content.nejm.org/cgi/reprint/339/27/1957.pdf">Link to article on publisher's site</a>
dc.identifier.issn0028-4793 (Linking)
dc.identifier.pmid9869666
dc.identifier.urihttp://hdl.handle.net/20.500.14038/47543
dc.description.abstractBACKGROUND: Many patients with hypertension have inadequate control of their blood pressure. Improving the treatment of hypertension requires an understanding of the ways in which physicians manage this condition and a means of assessing the efficacy of this care. METHODS: We examined the care of 800 hypertensive men at five Department of Veterans Affairs sites in New England over a two-year period. Their mean (+/-SD) age was 65.5+/-9.1 years, and the average duration of hypertension was 12.6+/-5.3 years. We used recursive partitioning to assess the probability that antihypertensive therapy would be increased at a given clinic visit using several variables. We then used these predictions to define the intensity of treatment for each patient during the study period, and we examined the associations between the intensity of treatment and the degree of control of blood pressure. RESULTS: Approximately 40 percent of the patients had a blood pressure of > or =160/90 mm Hg despite an average of more than six hypertension-related visits per year. Increases in therapy occurred during 6.7 percent of visits. Characteristics associated with an increase in antihypertensive therapy included increased levels of both systolic and diastolic blood pressure at that visit (but not previous visits), a previous change in therapy, the presence of coronary artery disease, and a scheduled visit. Patients who had more intensive therapy had significantly (P<0.01) better control of blood pressure. During the two-year period, systolic blood pressure declined by 6.3 mm Hg among patients with the most intensive treatment, but increased by 4.8 mm Hg among the patients with the least intensive treatment. CONCLUSIONS: In a selected population of older men, blood pressure was poorly controlled in many. Those who received more intensive medical therapy had better control. Many physicians are not aggressive enough in their approach to hypertension.
dc.language.isoen_US
dc.relation<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=9869666&dopt=Abstract">Link to Article in PubMed</a>
dc.relation.urlhttp://content.nejm.org/cgi/reprint/339/27/1957.pdf
dc.rightsCopyright © 1998 Massachusetts Medical Society. PDF posted as allowed by the publisher’s Author Permissions policy at https://www.nejm.org/author-center/permissions.
dc.subjectAged
dc.subjectAmbulatory Care
dc.subject*Blood Pressure
dc.subjectComorbidity
dc.subjectDecision Support Techniques
dc.subjectHealth Services Research
dc.subjectHospitals, Veterans
dc.subjectHumans
dc.subjectHypertension
dc.subjectMale
dc.subjectOffice Visits
dc.subject*Outcome and Process Assessment (Health Care)
dc.subjectOutpatient Clinics, Hospital
dc.subjectProbability
dc.subjectRandom Allocation
dc.subjectUnited States
dc.subjectBiostatistics
dc.subjectEpidemiology
dc.subjectHealth Services Research
dc.titleInadequate management of blood pressure in a hypertensive population
dc.typeJournal Article
dc.source.journaltitleThe New England journal of medicine
dc.source.volume339
dc.source.issue27
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/qhs_pp/678
dc.identifier.contextkey1378824
refterms.dateFOA2024-03-07T18:23:08Z
html.description.abstract<p>BACKGROUND: Many patients with hypertension have inadequate control of their blood pressure. Improving the treatment of hypertension requires an understanding of the ways in which physicians manage this condition and a means of assessing the efficacy of this care.</p> <p>METHODS: We examined the care of 800 hypertensive men at five Department of Veterans Affairs sites in New England over a two-year period. Their mean (+/-SD) age was 65.5+/-9.1 years, and the average duration of hypertension was 12.6+/-5.3 years. We used recursive partitioning to assess the probability that antihypertensive therapy would be increased at a given clinic visit using several variables. We then used these predictions to define the intensity of treatment for each patient during the study period, and we examined the associations between the intensity of treatment and the degree of control of blood pressure.</p> <p>RESULTS: Approximately 40 percent of the patients had a blood pressure of > or =160/90 mm Hg despite an average of more than six hypertension-related visits per year. Increases in therapy occurred during 6.7 percent of visits. Characteristics associated with an increase in antihypertensive therapy included increased levels of both systolic and diastolic blood pressure at that visit (but not previous visits), a previous change in therapy, the presence of coronary artery disease, and a scheduled visit. Patients who had more intensive therapy had significantly (P<0.01) better control of blood pressure. During the two-year period, systolic blood pressure declined by 6.3 mm Hg among patients with the most intensive treatment, but increased by 4.8 mm Hg among the patients with the least intensive treatment.</p> <p>CONCLUSIONS: In a selected population of older men, blood pressure was poorly controlled in many. Those who received more intensive medical therapy had better control. Many physicians are not aggressive enough in their approach to hypertension.</p>
dc.identifier.submissionpathqhs_pp/678
dc.contributor.departmentDepartment of Quantitative Health Sciences
dc.source.pages1957-63


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