The AMA MAP BP quality improvement program reduced uncontrolled BP by 8.4% to 19.4% across age and sex groups, with larger declines and lower therapeutic inertia in younger patients and males.
Observational (n=21,861)
Yes
Does a quality improvement program improve blood pressure control and reduce therapeutic inertia across different age and sex groups in patients with hypertension?
A quality improvement program improves blood pressure control, but significant age and sex disparities remain, with older patients and females experiencing higher therapeutic inertia.
Hypertension quality improvement programs reduce uncontrolled blood pressure (BP) but impact may differ by sex and age. This study examined uncontrolled BP, defined as a BP ≥ 140/90 mmHg, and therapeutic inertia, defined as absence of medication initiation or escalation during visits with uncontrolled BP, by sex and by age group (19-40, 41-65, 66-75, and 76+ years) during a 12 month follow-up period among 21, 861 patients with hypertension and ≥ two visits in primary care clinics enrolled in the American Medical Association (AMA) Measure Accurately, Act Rapidly, and Partner with Patients (MAP) BP hypertension quality improvement program. The mean age was 64.8 years (standard deviation SD 12.8) and ranged from 19 to 87 years; 53.6% were female. In age groups 19-40, 41-65, 66-75, 76-87 years, uncontrolled BP at the first clinic visit was present in 51.5%, 42.5%, 37.5% and 36.6% of males, respectively, and in 40.0%, 38.0%, 36.0% and 39.6% of females, respectively. Based on vital signs at the first vs. last clinic visit, the proportion of patients with uncontrolled BP in age groups 19-40, 41-65, 66-75 years declined by 19.4%, 13.5%, 10.1% and 8.7% in males, respectively, and 14.4%, 12.5%, 9.3%, and 8.4%, among females, respectively. Therapeutic inertia ranged from 66.5% and 75.9% of clinic visits among males and females age 19-40 years, to 85.6% and 84.9% of clinic visits among males and females age 76-87 years, respectively. The proportion of clinic visits with therapeutic inertia was lower among males vs. females across all age groups until age 76-87 years. A quality improvement program improves BP control but declines in uncontrolled BP are larger and therapeutic inertia is lower for younger vs. older age groups and for males vs. females. More interventions are needed to reduce sex and age disparities in hypertension management.
Myers et al. (Tue,) conducted a observational in Hypertension (n=21,861). AMA MAP BP hypertension quality improvement program was evaluated on Uncontrolled BP (≥ 140/90 mmHg) and therapeutic inertia. The AMA MAP BP quality improvement program reduced uncontrolled BP by 8.4% to 19.4% across age and sex groups, with larger declines and lower therapeutic inertia in younger patients and males.