P-330: Association of risk factors and complications on goal blood pressures among hypertensives managed by a nurse managed protocol with physician advice

• Published in: American journal of hypertension 2003-05, Vol.16 (S1), p.156A-156A
• Main Author: Carr, Albert A
• Format: Article
• Language: English
• Subjects: Blood Pressures; Goals; Guidelines
• ISSN: 0895-7061; 1941-7225
• DOI: 10.1016/S0895-7061(03)00495-3

less than The East Central Health District composed of 13 county Health Departments including Augusta provide protocol evaluation and management of hypertensives with low cost medications (hydrochlorothiazide, atenolol, verapamil, fosinopril, hydralazine, propranolol, reserpine and combination of reserpine-hydralazine-hydrochlorothiazide) for physician referred hypertensives because they cannot afford medications. Counseling is provided for low sodium diets and weight reduction, with a yearly electrocardiographic study, and fasting venous blood for lipid profile, glucose, K, Na and creatinine and CBC. Urine dipstick is available but not tests for albumin. Nurses provide the evaluation and management by a protocol with physician-Director availability by phone for advice. For the year ending December2002 548 hypertensives managed; 76.8% black; 74.5% female; 59.8 % obese; 67% with dyslipidemia; 19.7% with diabetes mellitus type 2; 4.7% with renal failure; 18.9% with left ventricular hypertrophy by electrocardiographic study; 13.3% with ischemia by electrocardiographic study and 7.8% with left ventricular hypertrophy and ischemia. Among the hypertensives 13.2% were without risks or complications; Goal for control of blood pressures in mm Hg 140 systolic and 90 diastolic. Those at goal were: overall- 61.9%; those without risks or complications-73.9%; those with risks or complications 60%; those with Dyslipidemia 65.4%; those with obesity-62.2%; those with diabetes-59.2%; those with renal failure-65.3%; those with left ventricular hypertrophy –48%; those with ischemia-56.1%; those with left ventricular hypertrophy and ischemia-39.0%. Basically those without complications on one or less medications; those with complications 1.3 medications and those with left ventricular hypertrophy 1.6 medication. Among these low-income hypertensives very few without risks or complications and obesity, dyslipidemia and diabetes a real problem. Dylipidemia, obesity or mild renal failure do not seem to be associated with lower % at goal. Among those with cardiac hypertrophy and or ischemia goal blood pressures much lower. Either more severe disease or medications not pushed enough to reach goal blood pressures.