Level of blood pressure above goal and clinical inertia in a Medicaid population.

Journal Article (Journal Article)

Failure to adjust hypertension therapy despite elevated blood pressure (BP) levels is an important contributor to lack of BP control. One possible explanation is that small elevations above goal BP are not concerning to clinicians. BP levels farther above goal, however, should be more likely to prompt clinical action. We reviewed 1 year's worth of primary care records of 3742 North Carolina Medicaid recipients 21 years and older with hypertension (a total of 15,516 office visits) to examine variations in hypertension management stratified by level of BP above goal and the association of BP level above goal with documented antihypertensive medication change. Among the 53% of patients not at goal BP, 42% were within 10/5 mm Hg of goal; 11% had a BP 40/20 mm Hg or higher above goal. Higher level of BP above goal was independently associated with antihypertensive medication change. Compared with visits at which BP was less than 10/5 mm Hg above goal, the adjusted odds of medication change were 7.9 (95% Confidence Interval 6.2-10.2) times greater at visits when patients' BP was 40/20 mm Hg or higher above goal. However, even when BP was above goal at this level, treatment change occurred only 46% (95% Confidence Interval 40.2-51.8) of the time.

Full Text

Duke Authors

Cited Authors

  • Viera, AJ; Schmid, D; Bostrom, S; Yow, A; Lawrence, W; DuBard, CA

Published Date

  • 2010

Published In

Volume / Issue

  • 4 / 5

Start / End Page

  • 244 - 254

PubMed ID

  • 20728422

Pubmed Central ID

  • PMC3124129

International Standard Serial Number (ISSN)

  • 1933-1711

Digital Object Identifier (DOI)

  • 10.1016/j.jash.2010.07.003


  • eng

Conference Location

  • United States