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dc.contributor.authorBorzecki, A. M.en_US
dc.contributor.authorKader, B.en_US
dc.contributor.authorBerlowitz, D. R.en_US
dc.date.accessioned2012-01-09T20:58:36Z
dc.date.available2012-01-09T20:58:36Z
dc.date.copyright2010
dc.date.issued2009-05-14
dc.identifier.citationBorzecki, A M, B Kader, D R Berlowitz. "The epidemiology and management of severe hypertension" Journal of Human Hypertension 24(1): 9-18. (2009)
dc.identifier.issn1476-5527
dc.identifier.urihttp://hdl.handle.net/2144/2934
dc.description.abstractHypertension guidelines stress that patients with severe hypertension (systolic blood pressure (BP)⩾180 or diastolic BP⩾110mmHg) require multiple drugs to achieve control and should have close follow-up to prevent adverse outcomes. However, little is known about the epidemiology or actual management of these patients. We retrospectively studied 59207 veterans with hypertension. Patients were categorized based on their highest average BP over an 18-month period (1 July 1999 to 31 December 2000) as controlled (<140/90mmHg), mild (140–159/90–99mmHg), moderate (160–179/100–109mmHg) and severe hypertension. We examined severe hypertension prevalence, pattern, duration, associated patient characteristics, time to subsequent visit, percentage of visits with a medication increase, and final BP control and antihypertensive medication adequacy. Twenty-three per cent had ⩾1 visit with severe hypertension, 42% of whom had at least two such visits; median day with severe hypertension was 80 (range 1–548). These subjects were significantly older, more likely black, and with more comorbidities than other hypertension subjects. Medication increases occurred at 20% of visits with mild hypertension compared to 40% with severe hypertension; P<0.05). At study end, 76% of patients with severe hypertension remained uncontrolled; severe hypertension subjects with uncontrolled BP were less likely to be on adequate therapy than those with controlled BP (43.7 vs 45.4%). Among hypertensive veterans, severe hypertension episodes are common. Many subjects had relatively prolonged elevations, with older, sicker subjects at highest risk. Although, follow-up times are shorter and antihypertensive medication use greater in severe hypertension subjects, they are still not being managed aggressively enough. Interventions to improve providers' management of these high-risk patients are needed.en_US
dc.language.isoenen_US
dc.publisherNature Publishing Groupen_US
dc.rightsCopyright 2010 Macmillan Publishers Limiteden_US
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/3.0/
dc.subjectEpidemiologyen_US
dc.subjectChronic hypertensionen_US
dc.subjectTherapyen_US
dc.titleThe Epidemiology and Management of Severe Hypertensionen_US
dc.typearticleen_US
dc.identifier.doi10.1038/jhh.2009.37
dc.identifier.pubmedid19440209
dc.identifier.pmcid3011090


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Copyright 2010 Macmillan Publishers Limited
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