P-201: Treatment and control of hypertension in the veterans health administration

• Published in: American journal of hypertension 2004-05, Vol.17 (S1), p.107A-107A
• Main Authors: Furmaga, Elaine M., Cunningham, Francesca E., Cushman, William C., Glassman, Peter A., Basile, Jan, Dong, Diane, Katz, Lois A., Rutan, Gale H.
• Format: Article
• Language: English
• Subjects: Antihypertensive Medications; Blood Pressure Control; Combination Therapy
• ISSN: 0895-7061; 1941-7225
• DOI: 10.1016/j.amjhyper.2004.03.276

The Department of Veterans Affairs (VA) Hypertension Field Advisory Committee, in collaboration with the VA Pharmacy Benefits Management (PBM), sought to evaluate utilization patterns, number of antihypertensive medications, and the effect on blood pressure (BP) control in veteran patients with hypertension (HTN). A descriptive analysis was performed with data obtained on patients with HTN receiving antihypertensive medication during fiscal years (FY) 2000–2002. Data on BP control from the Office of Quality and Performance were merged with a sample of the larger medication use cohort. Of over 3.6 million veterans enrolled in VA, approximately 42% have a diagnosis of HTN. In FY 2002, 94.4% of patients with a diagnosis of HTN were treated with antihypertensive medications. Utilization data by single agent (monotherapy) and combination therapy (2 or more agents) is depicted in Table 1. During FY 2000–2002, of those patients on therapy with 2 or 3 antihypertensive medications, a thiazide diuretic was prescribed in 34% and 46% of patients, respectively.Table 1Percent Utilization on Monotherapy and Combination Therapy Number of Medications FY 2000 FY 2001 FY 2002 1 32% 30% 28% 2 35% 35% 34% 3 21% 22% 24% > 3 12% 13% 14% In FY 2000, BP was controlled (< 140/90 mm Hg) in 49% of patients on monotherapy, 49% on 2 medications, and 47% on 3 medications, with BP in the 140–159/90–99 mm Hg range in 37%, 35%, and 34% of the respective therapy groups. In FY 2001, the percent with BP controlled increased to 55% on monotherapy, 56% on 2 medications, and 55% on 3 medications, with 34%, 32%, and 31% of patients in the 140–159/90–99 mm Hg range in the respective therapy groups. Between FY 2000–2002, fewer patients were being treated with monotherapy. Despite this trend toward utilizing combination therapy, providers often failed to include a thiazide-type diuretic as part of the antihypertensive regimen. It is encouraging however, that by FY 2001 approximately 55% of veterans were well controlled (BP < 140/90 mm Hg) on their antihypertensive medications, with another 30% having a BP in the 140–159/90–99 mm Hg range. The levels of BP control in the monotherapy and combination therapy groups present an opportunity to improve HTN management by intensifying therapy.