AIM: Primary care visits may not tackle hypertension with unrelated co-morbidities

Patients with more unrelated comorbid conditions are less likely to have uncontrolled hypertension addressed at a primary care visit, according to a study published in the April 15 issue of Annals of Internal Medicine.

Barbara J. Turner, MD, MSEd, University of Pennsylvania School of Medicine in Philadelphia, and colleagues undertook the study because “little is known about the quality of care received by patients with multiple unrelated conditions.”

The researchers examined a database derived from EMRs collected during routine care of a cohort of primary care patients from six primary care practices in Philadelphia, in order to investigate the association of unrelated comorbid conditions with treatment of uncontrolled hypertension in primary care visits.

Overall, the investigators studied the records of 15,459 patients with uncontrolled hypertension who made 70,557 visits to 200 clinicians from January 2004 through December 2006.

Turner and colleagues assessed the intensification of any antihypertensive treatment before the next visit. The authors also noted that the unrelated comorbid conditions included 28 conditions, such as arthritis and emphysema, whereas related comorbid conditions included vascular diseases.

At study visits, the researchers found that patients had a mean of 2.2 unrelated comorbid conditions. The adjusted odds of treatment intensification decreased with the number of unrelated comorbid conditions, from 0.85 for 1 to 0.59 for seven or more versus none, the authors wrote. The relationship between treatment intensification and unrelated comorbid conditions persisted at the visit, patient, and provider levels, according to the researchers.

The authors said that among their limitations, the reasons for not intensifying treatments are unknown; the recorded blood pressure may be inaccurate; and physicians may vary in their recording of comorbid conditions.

However, the researchers said that “effect of different types of comorbid conditions on meeting quality-of-care measures merits further investigation.”