Studies Show Wide Disparities in the Management of Uncontrolled Hypertension

Patients’ age, race, gender, reason for visiting the doctor’s office, and other factors can greatly affect prescribing patterns for antihypertensive medications

An article by Leland Kim, published on the University of California — San Francisco (UCSF) News Center website, notes that a study published in the Archives of Internal Medicine by Raman Khanna, MD, MAS, assistant clinical professor of the UCSF Department of Medicine, and colleagues found that “a patient who cites hypertension as a reason for a doctor’s visit is more than twice as likely to be prescribed a new medicine than a patient who doesn’t speak up.”

According to the UCSF article, “revealed that if blood pressure was not a reason for a clinic visit, a new medicine was prescribed 16 percent of the time. But if hypertension was a stated reason for the visit, a new medicine was prescribed 30 percent of the time. The adjusted odds were 2.6, which were highly statistically significant.”

The article quotes Khanna as saying that this low rate means “you would have to visit your doctor more than five times with high blood pressure before they would add or change a blood pressure medication. Saying, ‘I’m here for hypertension’ or ‘I’m here for my blood pressure check’ made a world of difference.”

The study used clinic data from the National Ambulatory Medical Care Survey (NAMCS) “based on 7,153 doctor’s offices visits representing 260 million office visits throughout the country.” Researchers looked at data for patients who were diagnosed with uncontrolled hypertension (defined for the purposes of the study as patients whose blood pressure measured greater than 140/90 during a doctor visit).

The UCSF article notes that the study had “major limitations.” For example, the study data used did not capture changes in doses to patients’ existing medications; it only recorded when patients switched medications. It also did not take into account whether a patient’s physician recommended exercise and/or dietary modifications as a means of controlling hypertension.

This study is not the first to note that a variety of factors can affect the type of care patients receive for hypertension:

• Study results published in 2010 in Preventive Medicine revealed a negative association between patient smoking status and hypertension management advice. Researchers found that being a current smoker was “significantly associated with lower odds” of being advised to reduce salt intake, engage in more exercise, and take medications to control blood pressure.
• An article published in 2008 in Hypertension found “no association between gender and use of any antihypertensive medication or initiating a new therapy among patients with uncontrolled hypertension,” but did find that women with uncontrolled hypertension were less likely than their male counterparts to be prescribed aspirin and beta-blockers for secondary prevention of cardiovascular disease
• Study results published in 2011 in Pediatrics revealed that “Older and white adolescents were more likely than younger and black adolescents to receive an antihypertensive prescription.”