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Implications of a Health Lifestyle and Medication Analysis for Improving Hypertension Control
Matthew R. Weir, MD;
Edward W. Maibach, PhD;
George L. Bakris, MD;
Henry R. Black, MD;
Purnima Chawla, PhD;
Franz H. Messerli, MD;
Joel M. Neutel, MD;
Michael A. Weber, MD
Arch Intern Med. 2000;160:481-490.
Background National Health and Nutritional Examination surveys have documented poor rates of hypertension treatment and control, leading to preventable morbidity and mortality.
Objectives To examine covariation in the medication and health lifestyle beliefs and behaviors of persons with hypertension to identify and profile distinct subgroups of patients.
Methods A sample of 727 patients with hypertension, weighted to match the1992 National Health Interview Survey age and sex distribution of patients with hypertension, was interviewed by telephone about their beliefs and behaviors regarding hypertension and its management. Cluster analysis of key variables was used to identify 4 patient types.
Results Subgroups differed significantly. Group A members use an effective mix of medication and health lifestyle regimens to control blood pressure. Group B members are most likely to depend on medication and have high adherence rates. Yet they also have high rates of smoking (29%) and alcohol use (average, 104 times per year) and are less likely to exercise regularly. Group C members are most likely to forget to take medication, are likely to be obese, and find it most difficult to comply with lifestyle changes (except for very low rates of smoking and alcohol use). Group D members are least likely to take medication, most likely to change or stop medication without consulting their physician (20%), most likely to smoke (40%), and least likely to control diet (29%). Group A and B members have better health outcomes than group C and D members.
Conclusions Optimal management strategies are likely to differ for the 4 patient types. Further research should be conducted to validate these findings on a separate sample and to devise and test tailored management algorithms for hypertension compliance and control.
From the Division of Nephrology, University of Maryland Hospital, Baltimore (Dr Weir); Porter Novelli, Washington, DC (Drs Maibach and Chawla); Rush–Presbyterian St Luke's Medical Center, Chicago, Ill (Drs Bakris and Black); Ochsner Clinic, New Orleans, La (Dr Messerli); University of California, Irvine (Dr Neutel); Brookdale Hospital Medical Center, Brooklyn, NY (Dr Weber).
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