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báo cáo khoa học: "Multiple uncontrolled conditions and blood pressure medication intensification: an observational study"

Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: Multiple uncontrolled conditions and blood pressure medication intensification: an observational study | Salanitro et al. Implementation Science 2010 5 55 http www.implementationscience.eom content 5 1 55 IMPLEMENTATION SCIENCE Implementation Science RESEARCH ARTICLE Open Access Multiple uncontrolled conditions and blood pressure medication intensification an observational study Amanda H Salanitro 1 2 3 Ellen Funkhouser2 4 Bonita S Agee2 Jeroan J Allison5 Jewell H Halanych4 Thomas K Houston5 6 Mark S Litaker2 7 Deborah A Levine8 9 and Monika M Safford4 Abstract Background Multiple uncontrolled medical conditions may act as competing demands for clinical decision making. We hypothesized that multiple uncontrolled cardiovascular risk factors would decrease blood pressure BP medication intensification among uncontrolled hypertensive patients. Methods We observed 946 encounters at two VA primary care clinics from May through August 2006. After each encounter clinicians recorded BP medication intensification BP medication was added or titrated . Demographic clinical and laboratory information were collected from the medical record. We examined BP medication intensification by presence and control of diabetes and or hyperlipidemia. Uncontrolled was defined as hemoglobin A1c for diabetes BP 140 90 mmHg 130 80 mmHg if diabetes present for hypertension and low density lipoprotein cholesterol LDL-c 130 mg dl 100 mg dl if diabetes present for hyperlipidemia. Hierarchical regression models accounted for patient clustering and adjusted medication intensification for age systolic BP and number of medications. Results Among 387 patients with uncontrolled hypertension 51.4 had diabetes 25.3 were uncontrolled and 73.4 had hyperlipidemia 22.7 were uncontrolled . The BP medication intensification rate was 34.9 overall but higher in individuals with uncontrolled diabetes and uncontrolled hyperlipidemia 52.8 overall and 70.6 if systolic BP 10 mmHg above goal. Intensification rates were lowest if diabetes or hyperlipidemia were controlled lower than if diabetes or hyperlipidemia were not .