Key result
In 8,735 patients managed in a nurse-physician clinic, overall hypertension control rates were 49.3-51.4%, but control was markedly lower in patients >60 years due to persistent systolic hypertension.
Why the study?
Does a nurse-physician clinic model achieve adequate hypertension control rates across different age groups?
Observational (n=8,735)
Does a nurse-physician clinic model achieve adequate hypertension control rates across different age groups?
A nurse-physician management model achieves high hypertension control rates in younger patients, but older patients (>60 years) continue to have poor control driven by persistent systolic hypertension.
Suboptimal control in older adults warrants caution with nurse-physician models; leaves open whether age-specific systolic strategies improve outcomes.
Hypertension control rates (BP <140/90) vary from 6 in the UK to 27% in the U.S. (NHANES III). Retrospectively, we analyzed 63,335 blood pressure measurements in 8,735 patients managed in the Division of Hypertension from 1997-2000. Using the nurse-physician clinic model for hypertension management, overall control rates were stable (49.3-51.4%) over the four years. Control was defined as the mean of the last two readings <140/90-mm Hg in each year for each patient. When control rates were analyzed by 20-year spans of age, control rates for patients > 60 years of age were markedly lower than for younger patients (Table 1). The differences in control rates between patients > 60 years of age and those less than 60 years were also seen when control was defined as: 1) the mean of all visits in a year was < 140/90 mm Hg for each patient, or 2) more than 50% of visits in each year during which the patient's BP was < 140/90 mm Hg. Failure to achieve blood pressure goals was almost always due to failure to reduce systolic BP to less than 140 mm Hg. Number (%) BP < 140/90 By 20-year spans of Age Number (%) BP < 140/90 By 20-year spans of Age Conclusion: For patients less than 60 years of age, the nurse-physician model of hypertension management results in control rates higher than reported elsewhere. Control rates for patients > 60 years are better than reported worldwide but still poor, this is due to persistent systolic hypertension. New treatment paradigms are necessary to improve control rates in the elderly.
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John W. Graves (2001) conducted an observational in Hypertension (n=8,735). Age > 60 years vs. Age < 60 years was evaluated on Hypertension control (mean of last two readings <140/90 mm Hg). In 8,735 patients managed in a nurse-physician clinic, overall hypertension control rates were 49.3-51.4%, but control was markedly lower in patients >60 years due to persistent systolic hypertension.
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