Abstract P364: Health Insurance Status Affects Hypertension Control in a Hospital Based General Internal Medicine Clinic

Abstract

Objectives: Hypertension is a worldwide disorder that contributes significantly to morbidity, mortality, and healthcare costs in both developed and developing communities. No previous US study has evaluated the factors associated with blood pressure (BP) control when easy access to health care is available to hypertensive patients. Methods: A retrospective cohort study of hypertensive patients attending the Internal Medicine continuity clinic at Nashville General Hospital (NGH) between January and December 2007 was conducted. Given the easy access to health care at NGH and affordable BP medications with a cost of about $4 for a 30 day supply, we explored the ability to achieve optimal guideline directed BP control and evaluated which factors are associated with achieving adequate blood pressure control. Results: Of the 199 study participants, 59% of the study population achieved optimal guideline directed BP goal < 140/90mmHg similar to the national average. The mean (95% CI) systolic BP (SBP) was 139 mmHg (136 - 141)mmHg while the mean (95% CI) diastolic BP (DBP) was 80 mmHg (79-82)mmHg. Health insurance status was associated with SBP and DBP (All P < 0.046). Patients with health insurance had a 2.2 fold increased odds of achieving optimal BP control to less than 140/90mmHg compared to patients without health insurance (P=0.025). Furthermore, the number of blood pressure medications used was significantly associated with SBP and DBP (All P < 0.003). Patients taking more than three BP medications had a 58% reduced odds of achieving adequate BP control less than 140/90mmHg compared to patients taking one medication (P = 0.039). Ethnicity was not associated with achieving BP control in this study. Conclusion: Our study revealed optimal guideline directed BP control can be achieved when easy access to health care is provided and with use of affordable medications. The number of BP medications used and health insurance status, are factors associated with achieving optimal BP control.