Compliance with the JNC 7 Guidelines and Blood Pressure Attainment in an Inner-City Tertiary Care Hospital

Abstract

Background:

Blood pressure control has demonstrated significant reductions in strokes and coronary events. Using an evidence-based approach, the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) guidelines recommend health-promoting lifestyle modifications, antihypertensive agents, and target blood pressure for different patient care groups.

Objective:

To assess medication selection(s) and blood pressure goal attainment in a large inner-city, hospital-based, primary care clinic.

Methods:

A 6 month retrospective, randomized, observational study was conducted to evaluate hypertension management in Bellevue Hospital's adult primary care clinic. Age, sex, ethnicity, comorbidities, blood pressure measurement, and antihypertensive treatment were obtained from computerized medical records. Antihypertensive medication selection was compared with recommendations given by the JNC 7 guidelines. Blood pressure goal attainment sorted by ethnicity, comorbidities, and age was assessed and compared with the National Health and Nutrition Examination Survey (NHANES) data.

Results:

A total of 210 patients were evaluated for antihypertensive agent(s) selection. Overall, 72% of patients received antihypertensive agents recommended by the JNC 7 guidelines. More patients in our primary care clinic achieved their systolic blood pressure goal compared with NHANES data. However, hypertensive management at our clinic was below the national average in goal diastolic blood pressure achievement. Patients with frequent follow-up visits were more likely to achieve their goal blood pressure. The most common antihypertensive agents prescribed were β-blockers (40%), followed by angiotensin-converting enzyme inhibitors (35%) and diuretics (33%).

Conclusions:

Hypertensive management in the outpatient primary care clinic of our institution warrants improvement in blood pressure goal attainment. Frequent follow-up clinic visits were associated with higher attainment rates of JNC 7 blood pressure goals.