Abstract 3863: Blood Pressure Control: Improvements Following Release of the JNC-7 Guidelines
Objective: This study compared blood pressure (BP) control rates and treatment patterns for patients diagnosed with hypertension (HTN) before and after publication of the JNC-7 guidelines.
Methods: As part of a national observational HTN study, patients aged ≥ 18 years from 23 managed care and physician groups were included. From data collected June 1998 to April 2006, two cohorts were defined; pre JNC-7 (June 1998 to March 2003) and post JNC-7 (December 2003 to April 2006). The HTN population, identified via claims data were verified during chart review of 17,371 randomly selected patients (15,359 patients pre JNC-7 and 2,012 patients post JNC-7). Variables of interest included demographic characteristics, comorbid conditions, BP control defined by JNC-7 in both cohorts, and treatment patterns. Statistical analysis included chi square testing.
Results: The mean age pre JNC-7 was 61.5 vs. 62.3 post JNC-7 and the percentage of females increased 56.2% to 65.0%. Common comorbidities pre and post JNC-7 were hyperlipidemia (52.4% and 59.5%; p < 0.0001) and diabetes (22.1%, and 27.0%; p < 0.0001). BP control improved 13.9% in the overall population post JNC-7 (39.3% to 53.2%; p < 0.0001) and increased 12.5% in patients with coexisting diabetes (16.7% to 29.2%; p < 0.0001). An increase (p < 0.001) in the number of patients prescribed more than one antihypertensive was noted during the pre to post JNC-7 timeframe as demonstrated by no treatment (21.4% vs 6.4%), monotherapy (45.8% vs 36.7%), dual therapy (23.2% vs 37.3%), and three or more agents (9.6% vs 19.6%). Highly utilized antihypertensives during the same timeframe were diuretics (24.8% vs 32.9%; p < 0.0001), beta-blockers (22.0% vs 25.4%; p = 0.0007), ACE inhibitors (21.9% vs 23.6%; p = NS), and calcium channel blockers (20.9% vs 23.6%; p = NS). Fixed-dose combination agents demonstrated the single-highest increase of all antihypertensive classes (10.1% vs 26.7%; p < 0.0001).
Conclusions: This study illustrates considerable improvements in BP control from 2003 to 2006. Implementation of JNC-7 guidelines may have been a catalyst to improve BP control among patients diagnosed with hypertension with and without diabetes. Providers should continue to follow JNC-7 guidelines when treating hypertension.