Assessment of the Treatment of Hypertension in a University HMO Ambulatory Clinic

• Objective: To determine the adequacy of hypertension treatment for patients enrolled in a university health maintenance organization (HMO). • Design: Retrospective review of medical records. • Patients and setting: 182 patients with an ICD-9 diagnosis code for benign essential hypertension seen between October 1995 and October 1997 in internal medicine and family practice clinics. • Methods: Blood pressure measurements, length of time between follow-up visits, initial and current drug therapy, and nonpharmacologic therapy were recorded. Recommendations for blood pressure control (< 140/90 mm Hg), staging of hypertension, followup times, and initial therapy (β blocker or diuretic, when appropriate) were based on Joint National Committee (JNC) guidelines. • Results: Antihypertensive therapy was prescribed for 96% of study patients. Blood pressure was controlled to less than 140/90 mm Hg in 38.2% of patients during the study period. Diuretics or β blockers were initially selected for 44% of patients. Time to follow-up visits for hypertension was in accordance with JNC recommendations 48.9% of the time. • Conclusion: Within a university HMO patient population, blood pressure control exceeded a national estimate of 29% control in hypertensive patients (NHANES-III survey). Further improvements can be made in nonpharmacologic management of hypertension, initial choice of drug therapy, blood pressure control, and time to follow-up.