Factors relating to inadequate control of blood pressure in hypertensive outpatients

Adequate control of blood pressure (BP) is important for preventing hypertensive complications, but it has been reported that many patients remain uncontrolled despite regular care. We studied the factors contributing to inadequate control of BP. A cohort of hypertensive patients (n=395) was queried in regard to their quality of life (QOL) and drug compliance, and the characteristics of responders (n=256) were obtained from their clinical records. The achieved level of BP was determined by the mean of at least five readings at five recent visits. The mean age, BP, and body mass index were 73.0+/-8.8 years, 139+/-12/76+/-8 mmHg, and 24.1+/-3.5, respectively. There was no significant relation between the BP level and the QOL score. The patients were divided into 6 groups according to their attending physicians (A, B, C, D, E, and F), and the BP levels were compared among the groups. Systolic BPs were higher in the A (143+/-13 mmHg) and the F (145+/-12 mmHg) groups than in the B (135-/+10 mmHg) group, whereas diastolic BPs were similar among the groups. Moreover, increases in therapy occurred at lower BP levels in the B group (158+/-13/83+/-14 mmHg, n=14) than in the A group (173+/-21/87+/-16 mmHg, n=8). Other characteristics of the clinical background were similar among the groups. Multivariate analysis indicated that inadequate BP control (greater than or equal to140/90 mmHg) was associated with difference of physicians (A, C, D, or F vs. 13), number of antihypertensive drugs (greater than or equal to 2 vs. 1), and increases in therapy (vs. no increases in therapy). These results suggest that physicians' attitudes toward anti hypertensive therapy play a crucial role in adequate BP control.