Pilot study of potential barriers to blood pressure control in patients with inadequately controlled hypertension

Background. Most people with high blood pressure (BP) are managed in primary care, but BP control is often inadequate. Objectives. To examine potential barriers to adequate BP control in patients with poorly controlled hypertension. Design: Cross-sectional survey. Setting. Computerized inner city general practice. Participants. Atotal of 155 hypertensive patients aged 50-80 years with last recorded BP >= 150/ 90 mm Hg (or >= 140/85 mm Hg if diabetic). Methods. Patients were invited to attend a nurse-led clinic where BP was measured according to a standardized protocol and patients were asked to complete a semi-structured questionnaire including lifestyle, compliance with treatment and knowledge about hypertension. Details of BP reviews were obtained from medical records. Results. A total of 110 patients (71%) with a mean age of 65 years attended the nurse-led clinic of whom 27% were of African origin. Of those who attended, 52 (47%) had adequately controlled BP when measured according to protocol. The remaining 58 (53%) had inadequately controlled BP. Of patients on treatment, 94% (83/88) reported taking it at least 6 days a week. Only 9% of patients knew their target BP and only 39% that treatment aims to prevent stroke or heart attack. Patients with diabetes were more likely than those without to have BP >= audit standard (79% 26/33 versus 42% 32/77, P < 0.001). Conclusion. About half of apparently uncontrolled hypertensive patients had BP below target when measured according to standard methods. Reported compliance was good; but patient knowledge of target BP was poor. Patients with diabetes were more likely than those without to have inadequately controlled BP.