Rate and Predictors of Blood Pressure Control in a Federal Qualified Health Center in Michigan: A Huge Concern?

Journal of Clinical Hypertension. 2013 Apr; 15(4):254-63

Adesuwa B. Olomu, Venu Gourineni, Jason L. Huang, Nirzari Pandya, Nephertiti Efeovbokhan, Janaki Samaraweera, Kamesh Parashar, Margaret Holmes-Rovner.

Department of Medicine, College of Medicine, Michigan State University, East Lansing, 48824, USA.

Nephertiti Efeovbokhan-1

Contact:

Ade Olomu, MD, MS,FACP
Associate Professor of Medicine
Department of Medicine
Michigan State University
East Lansing MI 48824
email: Ade.Olomu@hc.msu.edu

 

 

 

 

Abstract

Hypertension (HTN) is particularly burdensome in low-income groups. Federal-qualified health centers (FQHCs) provide care for low-income and medically underserved populations. To assess the rates and predictors of blood pressure (BP) control in an FQHC in Michigan, a retrospective analysis of all patients with HTN, coronary artery disease, and/or diabetes mellitus (DM) seen between January 2006 and December 2008 was conducted. Of 212 patients identified, 154 had a history of HTN and 122 had DM. BP control was achieved in 38.2% of the entire cohort and in 31.1% of patients with DM. The mean age was lower in patients with controlled BP in both the total population (P=.05) and the DM subgroup (P=.02). A logistic regression model found only female sex (odds ratio, 2.27; P=.02) to be associated with BP control and a trend towards an association of age with uncontrolled BP (odds ratio, 0.97; P=.06). BP control in nondiabetics was 47.8% vs 31.1% in diabetic patients (P=.02). We found that patients who attended the FQHC had a lower rate of BP control compared with the national average. Our study revealed a male sex disparity and significantly lower rate of BP control among DM patients.

PMID: 23551725

 

Supplement:

67 million American adults (31%) have high blood pressure—that’s 1 in every 3 American adults. 69% of people who have a first heart attack, 77% of people who have a first stroke, and 74% of people with chronic heart failure have high blood pressure. High blood pressure is also a major risk factor for kidney disease. More than 348,000 American deaths in 2009 included high blood pressure as a primary or contributing cause. High blood pressure costs the nation $47.5 billion annually in direct medical expenses and $3.5 billion each year in lost productivity. It’s estimated that about 47% of people with high blood pressure have their condition under control.

A 12- to 13-point reduction in blood pressure can reduce the number of heart attacks by 21%, strokes by 37% and all deaths from cardiovascular disease by 25%. One computer model suggests that for a 60-year-old diabetic man with hypertension, reducing blood pressure from less than 140/90 mm Hg to less than 130/85 mm Hg would increase life expectancy by 16.5-17.4 years as a result of clinical events prevented. Another study with more than 3,000 50-year-old participants found that total life expectancy was about 5 years longer for adults with normal blood pressure than those with hypertension.

These studies suggest that reducing blood pressure in patients with hypertension saves money and extends life expectancy. They also suggest that the medical, economic, and human costs of untreated and inadequately controlled high blood pressure are enormous.

Federally qualified health care centers (FQHC), along with rural health clinics and free clinics serve patients who live in medically underserved areas, have low income, are uninsured, live in rural areas, or have other characteristics that make it difficult to access care. FQHCs provide preventive and primary health care services to these patients who would otherwise have difficulty securing access to quality care. It’s estimated that about 20 million Americans receive health care from FQHCs.

My co-investigators and I designed a study, to assess the rate and predictor of blood pressure control in a federally qualified health care center. As FQHCs serve a substantial amount of the US population, adequate blood pressure control will lead to enormous cost saving and prolong lives.

We collected data on all patients presenting to the FQHC within a three year period. We analyzed several variables- gender, age, and blood pressure, medications used to control blood pressure, cardiovascular risks such as body mass index, cholesterol levels and more. We performed statistical analysis, descriptive and comparative analysis, univariate and multivariate analysis to assess the impact of several variables on blood pressure control.

The results of our study showed that blood pressure control was achieved in only 38.2% of the total cohort and in 31.1% of patients with diabetes well below the national average for the entire US population. We also found out that men and older individuals were less likely to have their blood pressure controlled. It provided awareness to health care providers on the poor blood pressure control in this cohort of patients. Some well-documented barriers to HTN control include patients’ unawareness of HTN and poor adherence and access to medical care. Our earlier studies in a FQHC revealed that educational sessions highlighting cardiovascular disease and its burden helped to improve patient knowledge and understanding about prevention and adherence to the medications.

What our findings highlight is the need to design interventions that focus on these safety-net clinics where minority and low-income populations receive their care.

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