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- Title
Hypertension guideline adherence among nursing home patients.
- Authors
Drawz, Paul E.; Bocirnea, Cristina; Greer, Katarina B.; Kim, Julian; Rader, Florian; Murray, Patrick
- Abstract
<bold>Background: </bold>Adherence to hypertension guidelines in the outpatient setting is low.<bold>Objective: </bold>To evaluate adherence to JNC VII guidelines in nursing home patients.<bold>Design: </bold>Data were obtained from the 2004 National Nursing Home Survey (NNHS), a nationally representative sample of US nursing homes. Patients with hypertension were identified using ICD-9 codes. Adherence to JNC VII guidelines was defined as the use of a thiazide diuretic in patients without a compelling indication for a different class of antihypertensive medication, such as diabetes, chronic kidney disease, coronary artery disease, congestive heart failure, or a history of stroke.<bold>Participants: </bold>There were 13,507 patients in the 2004 NNHS survey, of whom 7,129 had hypertension.<bold>Main Results: </bold>Of these 7,129 hypertensive patients, only 12.6% were on a thiazide. Out of the 7,129 hypertensive patients, 3,113 did not have diabetes, chronic kidney disease, coronary artery disease, congestive heart failure, or a history of stroke. Of these 3,113 patients, only 13.9% were on a thiazide. After excluding patients with a potential contraindication to a diuretic, such as hospice care or incontinence, only 18% were prescribed a thiazide. Of the 3,113 patients, 1,148 were on a single class of antihypertensive and more were prescribed a beta blocker, ACE inhibitor, calcium channel blocker, loop diuretic, and ARB than a thiazide diuretic.<bold>Conclusions: </bold>Adherence to hypertension guidelines among nursing home patients is low. The appropriate use of thiazide diuretics could reduce costs and improve blood pressure control and patient outcomes.
- Subjects
PATIENT compliance; GUIDELINES; HYPERTENSION; NURSING home patients; CHRONICALLY ill; OUTPATIENT medical care
- Publication
JGIM: Journal of General Internal Medicine, 2009, Vol 24, Issue 4, p499
- ISSN
0884-8734
- Publication type
journal article
- DOI
10.1007/s11606-009-0920-1