The Epidemiology and Management of Severe Hypertension

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dc.contributor.author Borzecki, A M en_US
dc.contributor.author Kader, B en_US
dc.contributor.author Berlowitz, D R en_US
dc.date.accessioned 2012-01-09T20:58:36Z
dc.date.available 2012-01-09T20:58:36Z
dc.date.copyright 2010 en_US
dc.date.issued 2009-05-14 en_US
dc.identifier.citation Borzecki, A M, B Kader, D R Berlowitz. "The epidemiology and management of severe hypertension" Journal of Human Hypertension 24(1): 9-18. (2009) en_US
dc.identifier.issn 1476-5527 en_US
dc.identifier.uri http://hdl.handle.net/2144/2934
dc.description.abstract Hypertension 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.iso en en_US
dc.publisher Nature Publishing Group en_US
dc.rights Copyright 2010 Macmillan Publishers Limited en_US
dc.rights.uri http://creativecommons.org/licenses/by-nc-nd/3.0/ en_US
dc.subject Epidemiology en_US
dc.subject Chronic hypertension en_US
dc.subject Therapy en_US
dc.title The Epidemiology and Management of Severe Hypertension en_US
dc.type article en_US
dc.identifier.doi 10.1038/jhh.2009.37 en_US
dc.identifier.pubmedid 19440209 en_US
dc.identifier.pmcid 3011090 en_US

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