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Abstract: PO1779

Age and Sex Disparities in Hypertension Treatment Inertia After Implementation of Target: BP

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Myers, Olivia, Loyola University Chicago, Chicago, Illinois, United States
  • Markossian, Talar, Loyola University Chicago, Chicago, Illinois, United States
  • Probst, Beatrice D., Loyola University Health System, Maywood, Illinois, United States
  • Habicht, Katherine, Loyola University Health System, Maywood, Illinois, United States
  • Kramer, Holly J., Loyola University Chicago, Chicago, Illinois, United States
Background

Blood pressure (BP) control decreases with advancing age among women but not men, but reasons for sex disparities remain uncertain. Our institution enrolled four large outpatient primary care clinics in the Target:BP hypertension improvement program in 2018. This hypertension improvement program included audit and feedback of physician prescribing practices of BP lowering medications. We examined the adjusted association of medication escalation, a measure of treatment inertia, with age group among adults with uncontrolled hypertension and determined whether this association is modified by sex. We hypothesized that medication escalation for BP control differs by age group and by sex.

Methods

Adults age ≥ 18 years with uncontrolled hypertension (BP ≥ 140/90 mmHg at last visit) receiving primary care at a clinic enrolled in Target:BP and ≥ 1 primary care visit during 2019 were included. Medication escalation was defined as a change in BP lowering medication class or dose during a visit when hypertension was uncontrolled. Mixed effects models were used to calculate adjusted odds of medication escalation by age group (≤ 65, 66-75, ≥ 76 years) after adjustment for demographics and co-morbidities. Interaction term of sex* age group was then fitted in fully adjusted mixed effects models and was significant (P < 0.001). Adjusted odds of medication escalation were then calculated by sex and by age group and adjusted prevalence of medication escalation by age group and by sex was calculated using marginal effects.

Results

Mean age of 5973 adults with uncontrolled hypertension was 65.2 (SD 6.2) years; 54.7% were women; 64.7%% were White, 24.0% were Black and 9.9% were Hispanic ethnicity. Figure (left panel) shows that adjusted prevalence of medication escalation declined with advancing age group among men and women combined. Right panel shows the decline in medication escalation with advancing age group differed by sex until age 76+ years.

Conclusion

Medication escalation for uncontrolled hypertension declines with advancing age and this age associated treatment inertia differs by sex.