A Large Cohort Study Evaluating Risk Factors Associated With Uncontrolled Hypertension

Abstract

Hypertension is the most common primary diagnosis in the United States. Risks for long‐term consequences such as myocardial infarction, heart failure, stroke, and kidney disease continue to significantly increase as long as hypertension remains uncontrolled. This retrospective cohort study of 661,075 patients identified with uncontrolled hypertension, defined as systolic blood pressure (SBP) ≥140 mm Hg and/or diastolic blood pressure (DBP) ≥90 mm Hg, from a large integrated healthcare organization was conducted to examine multiple patient characteristics to determine their association with uncontrolled hypertension. Multivariate analysis revealed that compared with Caucasians, African Americans (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.16–1.20) were significantly associated with uncontrolled hypertension, as were unpartnered populations (OR, 1.15; 95% CI, 1.14–1.17), number of antihypertensive medications prescribed (OR, 1.37; 95% CI, 1.33–1.41), and adherence to most antihypertensive medications. A secondary analysis found an association between uncontrolled blood pressure and Patient Health Questionnaire‐9 (PHQ‐9) score (OR, 1.21; 95% CI, 1.16–1.26). Our findings suggest that the presence of these identified risk factors recommends a commitment to a more aggressive hypertension management program to prevent cardiovascular disease caused by uncontrolled hypertension.

Identification and Evaluation of Risk Factors in Patients With Continuously Uncontrolled Hypertension

“…13 Factors previously identified to be associated with uncontrolled hypertension included ethnicity (eg, African American), drug classes (ie, DHP CCB, sympatholytics, and vasodilators), partnered status, and higher scores on the PHQ-9 scale (ie, moderate to severe depression). 13 Within the uncontrolled cohort we found a large number of patients with recorded BPs never within goal and yet did not necessarily fit the traditional definition of resistant hypertension (ie, three or more antihypertensives from different classes at optimal doses but with BP not at goal). 20 To examine this group further, we limited our cases to those who had all reported BPs (at least 18 consecutive months of data) greater than goal.…”

“…This study was designed to probe deeper to identify previously undescribed risk factors associated with uncontrolled hypertension. Since ethnicity was previously described as a risk factor for uncontrolled hypertension in this population, 13 we decided to match patients based on ethnicity. 13,[16][17][18] In order to match appropriately, some control patients were used more than once.…”

“…In addition, family history of hypertension, thiazidenaive status (defined as those who have not been dispensed a thiazide medication dating as far back as 1996 in the EMR), total number and therapeutic classes of hypertensive medications dispensed, number of chronic medications (defined as at least 200 consecutive days' supply within the past 6 months of the last BP reading 13 ), and hours of exercise per week were analyzed. The hours of weekly exercise were a selfreported variable, and if it was not reported, then it was assumed zero hours per week.…”

“…A recently published retrospective cohort study by our research group 13 identified several factors associated with uncontrolled hypertension: African American race, unpartnered relationship status, and high number of dispensed antihypertensive medications. In addition, nonadherence to antihypertensive medications and the presence of moderate depression (identified through Patient Health Questionnaire-9 score ≥10) were also found to be associated with uncontrolled hypertension.…”

Life Quality of Persons With Arterial Hypertension in Russia — Is There Relation to Treatment? (By Data From Populational Study Esse-Rf)

“…В этой связи важна выявленная в настоящем исследовании ассо-циация статуса лечения АГ и показателей КЖ рос-сиян. В ряде исследований показано улучшение КЖ на фоне лечения АГ и улучшения ее контроля [12,22], причем КЖ рассматривалось в связи с назначением АГП как один из критериев эффективности проводи-мой терапии [7]. Такой анализ проводится до и после подбора терапии, как правило, в ограниченном вре-менном интервале.…”