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Hypertension in older urban Native-American primary care patients

TitleHypertension in older urban Native-American primary care patients
Publication TypeJournal Article
Year of Publication2003
AuthorsRhoades, DA, Buchwald, D
JournalJ Am Geriatr SocJ Am Geriatr Soc
Date PublishedJun
ISBN Number0002-8614 (Print)<br/>0002-8614 (Linking)
Accession Number12757563
KeywordsAged, Cohort Studies, Comorbidity, Female, Humans, Hypertension/ diagnosis/ ethnology/therapy, Indians, North American/ statistics & numerical data, Male, Middle Aged, Prevalence, Primary Health Care/ statistics & numerical data, Quality Indicators, Health Care/standards, Quality of Health Care, Retrospective Studies, United States/epidemiology, Urban Population/statistics & numerical data
AbstractOBJECTIVES: To examine hypertension and its management in a population of older urban American Indians and Alaska Natives (AI/ANs). DESIGN: Retrospective cohort study using medical record review. SETTING: Urban health clinic serving predominantly AI/ANs in the Pacific Northwest. PARTICIPANTS: Five hundred twenty-four AI/ANs aged 50 and older seen between 1994 and 1995. MEASUREMENTS: Frequency of diagnosed hypertension, undiagnosed hypertension, comorbid conditions, hypertension treatment, control, and quality of care. RESULTS: The prevalence of diagnosed hypertension was 38%, and the prevalence of possible undiagnosed hypertension was 23%. Patients with diagnosed hypertension were more likely to be obese (age-adjusted odds ratio (OR) = 3.5), have diabetes mellitus (DM) (OR = 2.2), depression (OR = 1.7), heart disease (OR = 3.8), or renal disease (OR = 5.6) than patients without hypertension. Undiagnosed hypertension was inversely associated with number of health problems (OR = 0.8). Eighty-one percent of diagnosed patients were treated pharmacologically, but no factors associated with nontreatment were identified. Diuretic and beta-blocker usage was low. Patients with DM used angiotensin-converting enzyme inhibitors more frequently than patients without DM (OR = 2.4). Blood pressure was well controlled in 37%, with men being less well controlled than women (OR = 0.5). Serum cholesterol, creatinine, and retinal screening were performed more often than urinalyses or electrocardiograms. Lifestyle-modification counseling was uncommon. Number of health problems was the most common factor associated with screening tests for end-organ disease. CONCLUSION: Few studies have examined the care of older urban AI/ANs. Improvements are needed in adherence to recommendations for the detection, management, and monitoring of hypertension and its complications in older urban AI/ANs.
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