Hypertension Treatment And Control Among Patients Hospitalized With Heart Failure: An Analysis Of Get With The Guidelines Heart Failure

Background: Hypertension is a major factor associated with heart failure (HF).While effective blood pressure (BP) control is recommended in patients with HF, little is known regarding treatment and control rates in these patients. Methods: The analyses assessed HF patients from 195 hospitals participating in the GWTG-HF quality improvement program from January 2005 through September 2006. Patients with hypertension were assessed for number and type of hypertension treatment as well as BP control rates. Analyses were stratified by race-sex groups with multivariate logistic regression models using the generalized estimating equations methods assessed the factors associated with multiple treatment, type of therapy, and BP control levels. Results: Of 37,318 HF patients, 62.3% (23,257) had diagnosed hypertension. The majority (67.3%) of these high-risk individuals were treated with 3 or more hypertension drugs, which was significantly varied by race-sex groups. The use of ACEI (64.6%), beta blockers (79.9%), angiotensin receptor blockers (18.5%), diuretics (62.4%), loop diuretic (73.8%), and calcium channel blockers (13.3%) significantly varied by race-sex groups. BP control rates (< 140/90 mm Hg) at discharge significantly varied by race-sex group (total 70.8%; white males (WM) 76.3%; white females (WF) 71.1%; black males (BM) 63.0%; and black females (BF) 62.9%). Significant factors associated with BP control at discharge included age, race-sex (WF vs. BF, WM vs. BF), atrial fibrillation, hyperlipidemia, coronary heart disease, ICD, pacemaker, history of MI, and not having one or more of the following co-morbid conditions: diabetes, peripheral vascular disease, CVA and renal disease. Control rates considering BP < 130/80 mm Hg (52.3%) showed similar significant variation by race-sex group (WM 57.4%; WF 53.7%; BM 42.3%.; and BF 44.4%). Conclusions: The less than optimal blood pressure control levels and the gender/racial disparities support continued emphasis on hypertension treatment and control among patients with heart failure.