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Supported by an unrestricted grant from Marion Merrell Dow, Inc.
To identify correlates of controlled hypertension in a largely minority population of treated hypertensive patients.
Urban, public hospital.
A consecutive sample of patients who were aware of their diagnosis of hypertension for at least 1 month and had previously filled an antihypertensive prescription. Control patients had a systolic blood pressure (SBP) ≤ 140 mm Hg and diastolic blood pressure (DBP) ≤ 90 mm Hg, and case patients had a SBP ≥ 180 mm Hg or DBP ≥ 110 mm Hg.
Control subjects had a mean blood pressure (BP) of 130/80 mm Hg and case subjects had a mean BP of 193/106 mm Hg. Baseline demographic characteristics between the 88 case and the 133 control subjects were not significantly different. In a logistic regression model, after adjusting for age, gender, race, education, owning a telephone, and family income, controlled hypertension was associated with having a regular source of care (odds ratio [OR] 7.93; 95% confidence interval [CI] 3.86, 16.29), having been to a doctor in the previous 6 months (OR 4.81; 1.14, 20.31), reporting that cost was not a deterrent to buying their antihypertensive medication (OR 3.63; 1.59, 8.28), and having insurance (OR 2.15; 1.02, 4.52). Being compliant with antihypertensive medication regimens was of borderline significance (OR 1.96; 0.99, 3.88). A secondary analysis found that patients with Medicaid coverage were significantly less likely than the uninsured to report cost as a barrier to purchasing antihypertensive medications and seeing a physician.
The absence of out-of-pocket expenditures under Medicaid for medications and physician care may contribute significantly to BP control. Improved access to a regular source of care and increased sensitivity to medication costs for all patients may lead to improved BP control in an indigent, inner-city population.