Physician triffers for changing pharmacological treatment in hypertensive pateients [article]

Sean Patrick
Hypertension is the number one reason to visit the family physician in Canada and is responsible for substantial health care expenses. Approximately one third of communitydwelling Canadians with hypertension have blood pressure (BP) levels exceeding recommended thresholds, and this is partly related to a physician's willingness to alter drug treatment in hypertensive patients. The primary objective of this quality improvement study was to compare the factors that differ between patients with
more » ... en patients with controlled and uncontrolled BP in order to identify potential physician triggers for alteration of drug therapy in hypertensive patients or those with high BP. Patient files from the Kaye Edmonton Clinic were analyzed and relevant patient demographics, health history, current medications, and changes to BP were recorded. A chi-square analysis was then used to determine any significant differences between patients with controlled and uncontrolled BP. Only one significant difference was noted: patients with a controlled BP responded more positively to changes in drug therapy compared to patients with uncontrolled BP. Nonetheless, patients with a controlled BP were often younger and had a shorter duration of hypertension. These findings offer potential physician triggers that need to be investigated further. A future study involving a longer period and wider study population is needed in order to obtain more meaningful information regarding when to alter drug therapy. Key words Hypertension, HTN, blood pressure, guideline adherence, drug therapy, quality improvement Research Paper Patrick Uncertainty regarding a patient's true baseline BP 24, 25 , perceived risk of pharmacological treatment 11, 14, 26, 27 , lack of outcome expectancy 28, 29 , difficulty communicating to and Research Paper Patrick 4 educating patients 14 , and external factors such as resources and facilities 13, 21, 30, 31 are just a few more pertinent factors. Patient factors also exist, which can influence a physician's decision to alter therapy. Although factors impeding adequate BP control include health beliefs, clinical factors, demographic characteristics, and socioeconomic factors, one of the most commonly cited reasons for the failure to achieve BP targets is patient non-adherence 12, 32-34 . Studies show that only about two thirds of individuals take their entire prescribed dosage of antihypertensives, and this adherence has not improved significantly over the years 34, 35 . Patient nonadherence has been associated with inconvenient or costly drug regimens 12, 34, 36-44 , duration of treatment 40 , cost/benefit to receiving treatment 45 , social factors such as stigma and depression 43, 46 , patient awareness of treatment 8, 12, 47 , and inadequate education or understanding provided by the physician 14, 43-45, 48 . An earlier study by Berlowitz et al. (1998) actually managed to characterize the factors associated with an increase in antihypertensive treatment. Alterations to drug therapy were thought to be influenced by a scheduled visit, prior changes in therapy, an increase in systolic and diastolic BP during the time of visit but not previous visits, and the presence of CHD. Patient factors such as one's age, cardiovascular risk factors other than high BP, and complications resulting from hypertension did not serve as physician triggers to changing the pharmacological treatment of hypertension in patients. Only those with d a BP of <165/<90 mmHg were associated with an increase in the likelihood of therapy alteration. However, despite the findings, this study was limited by its study population, which included 800 male veterans with hypertension most of whom were elderly, white, and had many coexisting conditions. One would think that knowledge of Research Paper Patrick 5
doi:10.7939/r3-fpzs-b046 fatcat:qqm5wn3nl5hxpnjbykn5apdotm