Predictors of blood pressure control among hypertensives in community health centers

Abstract

Background: The correlates of blood pressure (BP) control among hypertensive individuals who have access to care in community-based health-care settings are poorly characterized, particularly among minority and immigrant populations.

Methods: Using data extracted from electronic medical records in four federally qualified health centers in New York, we investigated correlates of hypertension (HTN) control in cross-sectional analyses. The sample consisted of adult, nonobstetric patients with a diagnosis of HTN and a clinic visit between June 2007 and October 2008 (n = 2,585).

Results: Forty-nine percent of hypertensive patients had controlled BP at their last visit. Blacks had a higher prevalence of HTN (B, 32.8%; W, 16.2%; H, 11.5%) and were less likely to have controlled BP (B, 42.2%; W, 50.9%; H, 50.8%) compared with Hispanics and whites. Medication intensification did not differ by race/ethnicity. In multivariate analyses higher body mass index (BMI), black race, diabetes, fewer clinical encounters, and male gender were associated with poor BP control. However, when we applied the Seventh Report of the Joint National Committee (JNC 7) definition for BP control for nondiabetic patients (systolic blood pressure (SBP) <140, diastolic blood pressure (DBP) <90) to all patients with HTN, we found no difference in BP control between those with and without diabetes.

Conclusions: Blacks had poorer HTN control compared with whites and Hispanics. Significant discrepancies in BP control between hypertensive patients with and without diabetes may be related to a lack of provider adherence to JNC 7 guidelines that define BP control in this population as <130/80. Further research is needed to understand racial disparities in BP control as well as factors influencing clinician's management of BP among patients with diabetes.