Uncontrolled blood pressure in a treated, high-risk managed care population.

The prevalence of hypertension in the United States is increasing, and the estimated cost of care is more than USD 55 billion annually, including direct and indirect expenditures. The most recent National Health and Nutrition Examination Survey data show an improvement in awareness, treatment, and control of hypertension compared with previous surveys. Nonetheless, fewer than one third of adults with hypertension are achieving blood pressure control. The Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) states that most patients will require more than 1 drug to achieve goal blood pressure (<140/90 mm Hg, or <130/80 mm Hg for those with diabetes or chronic kidney disease). Hypertension is common in patients with diabetes, and aggressive blood pressure control has been shown to reduce the risk of these complications. In a study conducted from 2002 to 2005, the medical charts of 9492 adults with hypertension and diabetes from physician practices across the United States were reviewed. Only 27.5% of this high risk study population achieved the blood pressure goal of <130/80 mm Hg. Ninety-eight percent of patients were receiving antihypertensive therapy; 37.1% were using 1 agent, 34.4% were using 2, and 26.2% were using 3 or more agents. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers were the most frequently used antihypertensive agents in this study population, but they were underutilized, being used by 55.4% and 32.3%, respectively. These findings, which are consistent with other studies, suggest a need for improvement in management of hypertension in patients with diabetes and other high-risk groups.