Hypertension Control at Physicians' Offices in the United States. Commentary

BACKGROUND Uncontrolled hypertension is a common and important risk factor for heart disease and stroke. Nevertheless, the control rate among patients taking prescribed medication and/or therapeutic lifestyle modification has remained about the same for the past several decades. METHODS We analyzed 2003 and 2004 National Ambulatory Medical Care Survey (NAMCS) data to determine hypertension control in the physician offices in the United States. All visits for hypertension with measured blood pressure levels were included in the analyses. Survey weights were applied to obtain national estimates. Characteristics associated with hypertension control status were identified. RESULTS About 176 million hypertension-related office visits occurred (9.7% of total office visits) during 2003 and 2004. Of these, 17,44, and 62% of visits had blood pressure <130/80 mm Hg, 140/90 mm Hg, and 145/95 mm Hg, respectively. The likelihood of hypertension control (<140/90 mm Hg) was associated with a diagnosis of coronary heart disease (odds ratio (OR) 1.54,95% confidence interval (Cl) = 1.01-2.35), visits with increased serum cholesterol (OR = 1.34,95% Cl = 1.09-1.65), visits with patients'primary care physician vs. those with non-primary care physicians (OR = 1.49,95% Cl = 1.05-2.10), and visits with internists (OR = 1.32,95% Cl = 1.05-1.67) or cardiologists (OR = 1.70,95% Cl = 1.17-2.471) vs. those with family physicians. Age, gender, race/ethnicity, health insurance status, and prescription of types of antihypertensive medicine were not associated with hypertension control in office visits. CONCLUSIONS The hypertension control rate of 44% in US office visits leaves substantial room for improvement. A strong emphasis on improving hypertension management is needed to reduce hypertension-related morbidity and mortality.