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. 2009 Apr;24(4):499-503.
doi: 10.1007/s11606-009-0920-1. Epub 2009 Feb 7.

Hypertension guideline adherence among nursing home patients

Paul E Drawz  1 , Cristina Bocirnea, Katarina B Greer, Julian Kim, Florian Rader, Patrick Murray
Affiliations

Hypertension guideline adherence among nursing home patients

Paul E Drawz et al. J Gen Intern Med. 2009 Apr.

Abstract

Background: Adherence to hypertension guidelines in the outpatient setting is low.

Objective: To evaluate adherence to JNC VII guidelines in nursing home patients.

Design: Data were obtained from the 2004 National Nursing Home Survey (NNHS), a nationally representative sample of US nursing homes. Patients with hypertension were identified using ICD-9 codes. Adherence to JNC VII guidelines was defined as the use of a thiazide diuretic in patients without a compelling indication for a different class of antihypertensive medication, such as diabetes, chronic kidney disease, coronary artery disease, congestive heart failure, or a history of stroke.

Participants: There were 13,507 patients in the 2004 NNHS survey, of whom 7,129 had hypertension.

Main results: Of these 7,129 hypertensive patients, only 12.6% were on a thiazide. Out of the 7,129 hypertensive patients, 3,113 did not have diabetes, chronic kidney disease, coronary artery disease, congestive heart failure, or a history of stroke. Of these 3,113 patients, only 13.9% were on a thiazide. After excluding patients with a potential contraindication to a diuretic, such as hospice care or incontinence, only 18% were prescribed a thiazide. Of the 3,113 patients, 1,148 were on a single class of antihypertensive and more were prescribed a beta blocker, ACE inhibitor, calcium channel blocker, loop diuretic, and ARB than a thiazide diuretic.

Conclusions: Adherence to hypertension guidelines among nursing home patients is low. The appropriate use of thiazide diuretics could reduce costs and improve blood pressure control and patient outcomes.

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Figures

Figure 1
Figure 1
Flow diagram for patients in the 2004 National Nursing Home Survey (NNHS).
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