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The epidemiology and management of severe hypertension
Journal of Human Hypertension, 05/18/09

Borzecki AM et al. – Despite shorter follow-up times and greater use of antihypertensive medication in severe hypertension, management of these pts is not sufficiently aggressive.

Methods

Retrospective study of 59,207 veterans with hypertension
Classification of pts based on highest average BP over 18-mo period: controlled (<140/90 mm Hg), mild (140–159/90–99 mm Hg), moderate (160–179/100–109 mm Hg), severe hypertension
Evaluation of severe hypertension prevalence, pattern, duration, associated pt characteristics, time to subsequent visit, percentage of visits with a medication increase, and final BP control and antihypertensive medication adequacy

Results

≥1 visit with severe hypertension for 23%, of whom 42% had ≥2 such visits
Median day with severe hypertension: 80 (range 1–548)
Pt characteristics: significantly older, more likely black, more comorbidities for these subjects vs hypertension subjects
Medication increases at 20% of visits with mild hypertension vs 40% with severe hypertension
At study end, 76% of pts with severe hypertension remained uncontrolled
Severe hypertension subjects with uncontrolled BP less likely to be on adequate therapy vs controlled BP pts (43.7 vs 45.4%)
Common severe hypertension episodes for hypertensive veterans
Relatively prolonged elevations for most subjects; older, sicker subjects at highest risk

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