Do physicians aggressively intensify medical treatment of hypertension?

A previous report by Berlowitz et al., (NEJM, 33:1957, 1998) suggested that an important factor in the poor control rates of hypertension is that physicians were not aggressive enough in intensifying medical therapy: in only 25% of visits in which elevated blood pressures were recorded did physicians increase medications. However, the patients in this study were predominantly older white males within the VA system, which may not be representative of medical practices in general. The purpose of this study was to determine if a similar inadequacy exits within a community based clinic serving primarily African American patients. One hundred charts were reviewed for patients with a primary diagnosis of hypertension who had their first visit to the clinic in 1998. These chart reviews were completed using an instrument designed to examine the adherence of community physicians to the JNC VI guidelines. At initial evaluation, 39% had Stage I, 31% had Stage II and 15% had Stage III hypertension. In contrast to the VA study, we found that health professionals intensified medical therapy in 58% of patients who had an elevated blood pressure at their visit (n=85). Medical therapy was intensified in 45% of Stage I patients, in 68% of Stage II patients and in 80% of Stage III patients. For those patients who kept at least one of their follow-up appointments during the next year (67%), there was significant decrease in systolic and diastolic blood pressures (from 151 ± 19 mm Hg to 145 ± 20 mm Hg, p < 0.05, and from 92 ± 12 mm Hg to 85 ± 13 mm Hg, p < 0.001). In conclusion, these data show while there is room for improvement, physicians did intensify medical therapy for the majority of patients with Stage II and III hypertension in this community based clinic, resulting in improved control of blood pressure.