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Abstract: PO1771

Hypertension in the US Veterans Health Administration: Updated Prevalence and Risk Factors for Poor Blood Pressure Control

Session Information

Category: Hypertension and CVD

  • 1401 Hypertension and CVD: Epidemiology, Risk Factors, and Prevention

Authors

  • Yamada, Masaaki, Center for Access & Delivery Research and Evaluation, Iowa City VAMC, Iowa City, Iowa, United States
  • Sambharia, Meenakshi, The University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, United States
  • Wachsmuth, Jason, Center for Access & Delivery Research and Evaluation, Iowa City VAMC, Iowa City, Iowa, United States
  • Griffin, Benjamin R., Center for Access & Delivery Research and Evaluation, Iowa City VAMC, Iowa City, Iowa, United States
  • Swee, Melissa L., The University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, United States
  • Girotra, Saket R., Center for Access & Delivery Research and Evaluation, Iowa City VAMC, Iowa City, Iowa, United States
  • Reisinger, Heather, Center for Access & Delivery Research and Evaluation, Iowa City VAMC, Iowa City, Iowa, United States
  • Lund, Brian C., Iowa City VA Medical Center, Iowa City, Iowa, United States
  • Sarrazin, Mary Vaughan, Center for Access & Delivery Research and Evaluation, Iowa City VAMC, Iowa City, Iowa, United States
  • Jalal, Diana I., Center for Access & Delivery Research and Evaluation, Iowa City VAMC, Iowa City, Iowa, United States
Background

The Veterans Health Administration (VHA) management guideline recently redefined the blood pressure (BP) cut-off for hypertension diagnosis as ≥130/90 mmHg and recommended a BP goal of <130/90 mmHg for patients with known hypertension. We evaluated the impact of the new definition on the prevalence of hypertension and explored the clinical predictors for uncontrolled BP based on the new treatment goal.

Methods

We retrospectively analyzed data from VHA including Veterans with ≥2 office BP measurements between January 2016 and December 2017. If more than one BP value was available, we used the lowest of the day. Prevalent hypertension was defined as diagnostic codes related to hypertension, prescribed anti-hypertensive drugs, or based on office BP values. We then evaluated the clinical variables associated with uncontrolled BP (mean BP ≥130/90 mmHg) via multivariable logistic regression with risk estimates expressed as relative risk.

Results

Of the 1,959,337 Veterans eligible for inclusion in the analysis, we found that 1,394,230 (71%) and 1,594,093 (81%) met the hypertension diagnosis criteria including ≥140/90 and ≥130/90 mmHg, respectively. Among those who met the diagnosis hypertension criteria including BP ≥130/90 mmHg (n=1,594,093), 34% (n=538,947) had controlled BP (mean BP <130/90 mmHg) and 66% (n=1,054,939) had uncontrolled BP (mean BP ≥130/90 mmHg). Older age, Black race, obesity, kidney disease, and prior cerebrovascular disease (CVD) were associated with increased risk of uncontrolled hypertension (Table 1).

Conclusion

Applying the new 130/90 cut-off to the definition of hypertension increased the prevalence of hypertension by 10% in VHA. Among those with hypertension, 66% of Veterans did not meet the new BP goal of <130/90 mmHg. In addition, our findings indicate the need for targeted interventions in high-risk individuals such as Veterans with obesity, kidney disease, CVD, or of Black race.

Table 1. Clinical Variables Associated with Uncontrolled Hypertension
VariableRelative Risk of uncontrolled Hypertension
Age (years)
<40
40-49
50-59
60-69
70-79
≥80
-
1.0 (REF)
1.09 (1.08-1.10)
1.18 (1.17-1.19)
1.27 (1.26-1.28)
1.31 (1.29-1.32)
1.36 (1.35-1.37)
Race
White
Black
-
1.0 (REF)
1.08 (1.07-1.08)
Kidney Disease1.04 (1.03-1.05)
Cerebrovascular Disease1.05 (1.04-1.06)

Funding

  • Veterans Affairs Support