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January 1, 2003Hypertension ResearchOpen Access

Factors Relating to Inadequate Control of Blood Pressure in Hypertensive Outpatients.

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Key result

Differences in attending physicians' practice patterns were significantly associated with inadequate blood pressure control, with patients of less aggressive physicians having up to 5.47 times higher odds of uncontrolled hypertension.

Why the study?

Does the attending physician's attitude toward antihypertensive therapy affect inadequate blood pressure control in hypertensive outpatients?

Population

256 hypertensive outpatients visiting Otsuki Hospital in Kochi, Japan, with duration of antihypertensive…

Comparison

Management by different attending physicians… vs Management by attending physician B

Design

Cross-sectional

Authors

AOAyumu OnoTFToshiro Fujita

Discussion

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Overview

Physician practice variation was associated with uncontrolled hypertension; leaves open whether modifying physician behavior improves outcomes.

Study Design

Type

Cross-Sectional (n=256)

Multicenter

No

Structured PICO

Does the attending physician's attitude toward antihypertensive therapy affect inadequate blood pressure control in hypertensive outpatients?

P
Population
256 hypertensive outpatients (mean age 73 years, 62% female) treated for at least 6 months at a single center in Japan, evaluated cross-sectionally for factors associated with inadequate blood pressure control.
E
Exposure
Management by different attending physicians (A, C, D, E, F) with varying attitudes toward intensifying antihypertensive therapy
C
Comparator
Management by attending physician B (who intensified therapy at lower BP levels)
O
Outcome
Inadequate control of blood pressure (SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg)surrogate

Main Result

Odds Ratio: 5.47 (95% CI 2.17–13.81)

p-value: p=<0.001

Physicians' attitudes toward intensifying antihypertensive therapy play a crucial role in achieving adequate blood pressure control in outpatients.

Limitations

  • Cross-sectional design cannot rule out the possibility that patients with deteriorated QOL due to excessive hypotension dropped out from the analysis
  • Information on compliance in nonresponders to the questionnaire was not available
  • Cross-sectional design cannot rule out dropout of patients with deteriorated QOL due to excessive hypotension
  • Lack of compliance data for non-responders to the questionnaire

Cite This Study

Ono et al. (2003) conducted a cross-sectional in Hypertension (n=256). Attending physician practice patterns (Physician F vs. B) vs. Physician B (more aggressive treatment pattern) was evaluated on Inadequate blood pressure control (≥140/90 mmHg) (OR 5.47, 95% CI 2.17-13.81, p=<0.001). Differences in attending physicians' practice patterns were significantly associated with inadequate blood pressure control, with patients of less aggressive physicians having up to 5.47 times higher odds of uncontrolled hypertension.

synapsesocial.com/papers/6a22ed264cc0f16e7ccac0a6https://doi.org/10.1291/hypres.26.219
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Also Consider

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  1. 1Predictors of Uncontrolled Hypertension in Ambulatory Patients2001 · 213 citations
  2. 2Inadequate Management of Blood Pressure in a Hypertensive Population1998 · 967 citations
  3. 3Characteristics of Patients with Uncontrolled Hypertension in the United States2001 · 860 citations
  4. 4Trends in Hypertension Prevalence, Treatment, and Control In a Well-Defined Older Population1998 · 59 citations
  5. 5Predisposing Factors for Severe, Uncontrolled Hypertension in an Inner-City Minority Population1992 · 313 citations