Background It is plausible that hypertensive older adults with outpatient prescription drug benefit (OPDB) attain better blood pressure control than those without OPDB; however, this has not been rigorously studied.
Methods We performed a one-year retrospective cohort study among participants in Health ABC, a cohort of 3,075 well-functioning black and white men and women aged 70-79 years from Memphis, TN, and Pittsburgh, PA. Hypertension (HTN) was defined using JNC-VII criteria. Participants were informed if their blood pressure was elevated. Detailed health and socioeconomic information was obtained at baseline and participants had standardized measurements of blood pressure annually.
Results Of 3075 participants, 1192 (39%) had HTN. Of these, we excluded 20 participants for unknown status of OPDB. After one year, 643/1172 (55%) had persistent hypertension (pHTN), whereas the remaining 541 (45%) had controlled hypertension (cHTN). 402 (55%) of patients with OPDB had pHTN compared to 241 (55%) of those with no OPDB (OR = 1.0, 0.8-1.3). This relationship was unchanged when controlling for other sociodemographic and clinical factors (OR = 0.9, 0.8-1.0). In the multivariable analysis, having previous history of hypertension, hyperlipidemia, and being on antihypertensive medication, increased the odds for pHTN by 21%, 25%, and 28% (p < .03 in all cases) respectively. Depression and hospitalization decreased the odds ratio for pHTN by 47% (p = 012, p = .003 respectively).
Conclusion In this high-functioning older cohort with HTN, less than half achieved good BP control within a year of initial measurement. While OPDB was not associated with achieving control in this population, being on anti-hypertensive medication, hyperlipidemia, and previous history of hypertension were all associated with increased risk of pHTN.
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