This study tests the hypothesis that higher rates of blood pressure (BP) treatment intensification by primary care physicians (PCP) are correlated with higher rates of hypertension (HT) control in their patients.
We analyzed 280,423 patient encounters made by 57,101 HT adults with 127 primary care physicians (PCP) from 1/2/07 to 5/29/09. Data analyzed included demographics, BP values, pre-existing and newly prescribed BP drugs (ACE, ARB, diuretic, beta blocker, alpha blocker and calcium channel blocker), and diagnosis of diabetes, chronic kidney disease (CKD), or heart disease. The dependent variable was the proportion of each PCPs encounters with BP at goal. Independent variables included start of a new BP medication, increased dose of a pre-existing BP medication, visit interval between encounters, and comorbid conditions. Patients were considered at goal at a given encounter if BP was < 140/90 mm Hg or < 130/80 mm Hg in those with diabetes or CKD.
At 31% of their encounters patients with HT were not at goal. Of the patient encounters not at goal, 15.5% were started on a new class of BP medication and a higher use of this strategy correlated with a higher overall proportion of encounters at BP goal (r=.51; p<0.0001). At 14.9% of the encounters there was an upward adjustment of the dosage of an existing class of medication and a use of this strategy also correlated with overall proportion of patient encounters with BP at goal (r= .43 (p<0.0001). Shorter encounter interval was significantly correlated with better HT control (r=.21; p=0.0215) only for patients with stage 2 HT. Patients with diabetes (r=.38; <0.0001) or CKD (r=.21; p=0.02) were less likely than other patients to achieve recommended BP goals.
Higher rates of HT treatment intensification and shorter visit intervals (for stage 2 HT patients) were correlated with higher rates of HT control at the PCP level. Interventions that focus on these issues may have potential to improve rates of HT control in those with and without diabetes mellitus. Special emphasis on HT control in those with diabetes or CKD is warranted.