| Summary: | A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. === Background: Cardiovascular disease is the leading cause of mortality in the U.S. Risk factors identified for coronary artery disease, cerebrovascular disease, and kidney disease include uncontrolled blood pressure, diabetes, renal disease, hyperlipidemia, obesity, and tobacco use. The threshold for pharmacologic treatment of hypertension in patients with diabetes or chronic kidney disease is ≥130/80 mmHg. It may be of benefit to extend these criteria to individuals who have other cardiovascular disease risk factors and no diagnosis of hypertension. Blood pressure recommendations in this population have largely been unstudied. This study investigates blood pressure control in this non-hypertensive population.
Methods: We analyzed 2006 National Ambulatory Medical Care Survey (NAMCS) data to determine blood pressure control at physician office visits in the U.S. among patients with cardiovascular disease risk factors and no diagnosis of hypertension. Physician office visits with a documented diagnosis of hypertension were excluded from our study. Characteristics of the non-hypertensive population were indentified and were classified by blood pressure above or below 140/90 mmHg. Cardiovascular disease risk factors examined were diabetes,
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renal disease, hyperlipidemia, obesity, tobacco use, males >55 years, and females >65 years. This population was then divided into two groups, those with blood pressure above or below 130/80 mmHg.
Results: We found 22,744 records (77.4% of visits) with no diagnosis of hypertension out of 29,392 total records, with 43.2% of the non-hypertensive population having BP <140/90 mmHg. Males fulfilled criteria for hypertension (≥140/90 mmHg) more frequently than females (63.5% vs. 52.3%, P-value <.001). Patients were mostly younger than 65 years. Males >55 years was the most prevalent CVD risk factor, with 79.2% of these with BP ≥130/80 mmHg. Second most prevalent risk factor was tobacco use at 10.1% of non-hypertensive visits, and BP was ≥130/80 mmHg in 63.6% of these visits. Hyperlipidemia in 5.6% of total visits, with BP ≥130/80 mmHg in 60.5%. Obesity was documented in 5.5% of non-hypertensive population, with BP ≥130/80 mmHg in 60.0%. Visits with one risk factor with BP ≥130/80 mmHg were found in 22.8% of our non-hypertensive study population.
Conclusions: 56.8 % of those without a diagnosis of hypertension had elevated blood pressure recorded at their physician visit. BP control rate in our non-hypertensive population was 43.2%, surprisingly
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