Hypertension Management in the Outpatient Setting Ferrell

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Hypertension Managementin the Outpatient
SettingFerrell McClain MDKiernan Smith
MDTrident / MUSC Family Medicine Residency
Program
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Background

• Epidemiology
• gt50 million Americans have hypertension
• Uncontrolled hypertension
• 3 times more likely to develop CAD
• 6 times more likely to develop CHF
• Second only to diabetes as cause for ESRD

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Background

• National Success
• Since 1972
• Treatment of HTN 31 ? 59
• Control of HTN 10 ? 34
• Age adjusted death rates
• From Stroke have decreased 60
• From Coronary Heart Disease have decreased 50

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Background cont

• Guidelines
• The Seventh Report of the Joint National
  Committee on Prevention, Detection, Evaluation,
  and Treatment of High Blood Pressure (JNC 7)
• Question
• Are our patients receiving standard of care
  management of their hypertension?

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Purpose

• To access current blood pressure management,
  according to JNC VII guidelines, at The
  University Family Medicine Clinic and identify
  areas for improvement.
• National ? Local

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Methods

• Patients who have visited UFM in the last 12
  months
• Identified from two billing codes for
  hypertension
• 401.1 Benign Essential Hypertension
• 401.9 Unspecified Essential Hypertension
• Excluded those with diabetes or heart failure
• Different goals
• Studied elsewhere
• Excluded Pregnant Patients
• IRB exempt

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Methods

• Process measure from JNC VII guidelines
• BP check within the last 12 months
• Serum Creatinine check in last 12 months
• LDL checked in last 12 months
• Documented discussion of lifestyle modifications
• Use of anti-hypertensive agents
• Smoking Status

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Methods

• Goal Measurements
• BP lt 140/90
• LDL lt 160

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Results

• 237 patients met our criteria
• 65 patients reviewed so far
• 75 female, 25 male
• Mean age 55.7

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Outcome measures

• 100 had B/P measured in last 12 months
• 51.8 had achieved goal of lt 140/90 mmHg
• 78.6 had serum creatinine checked in last 12
  months

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Outcome measures cont

• 67.9 had LDL checked in last 12 months
• Of those checked 78.8 had LDL lt160
• Smoking
• 37.5 are current smokers
• 17.9 are former smokers
• 44.6 never smoked

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Outcome measures cont

• 57.1 received lifestyle counseling at the last
  visit
• Drug therapy
• Thiazide 71.4
• ACE 44.6
• ARB 7.1
• Beta Blocker 39.3
• Calcium Channel Blocker 23.2
• Other 10.7

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Limitations

• Some identified patients are diabetics (7)
• Some have not been seen in last year (2)
• LDL goal does not account for other risk factors
  patients may have
• Medication lists are not always accurate
• Reasons for discontinuing medications not always
  documented

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Discussion

• This hypertension registry analysis will allow us
  to see how well we are treating our hypertensive
  patients according to JNC VII guidelines

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Conclusion

• Persistent hypertension is one of the risk
  factors for strokes, heart attacks, heart failure
  and arterial aneurysm, and is a leading cause of
  chronic renal failure

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