Hypertension Responds to Primary-Care Doctor

Why are some patients able to keep their high blood pressure under control while others wind up in the hospital with a severe and dangerous medical emergency?

Lack of a primary-care doctor is the most important factor that puts such patients at risk of severe, uncontrolled hypertension, a new study of minority patients reports. Lack of health insurance also is a risk factor, suggesting the importance of financial barriers to care.

The study was conducted at two New York City hospitals, Harlem Hospital Center and Presbyterian Hospital, by researchers at Columbia University. Results were published in the New England Journal of Medicine.

“Improving access to primary-care physicians, through health insurance or other means, may be an effective strategy for improving control of hypertension in disadvantaged minority populations,” the researchers concluded.

Their study compared two groups of black and Latino patients treated at two New York City hospitals between late 1989 and mid-1991. One group included 93 patients who showed up in the emergency room with severe, uncontrolled hypertension. The 110 patients in the other group had a history of hypertension but were being treated for such other medical emergencies as intestinal problems, muscle spasms, allergies, backaches, hernias or ear infections.

Of the patients treated for severe, uncontrolled hypertension, 56% had no regular primary-care doctor and 38% had no health insurance. In the other group, by contrast, only 18% lacked a doctor and 17% lacked health insurance.

Patients with primary-care doctors were much more likely to have had their blood pressure checked regularly.

As in a previous study by the same researchers, almost all cases of hypertension treated at the two hospitals had been previously diagnosed and treated.

Hypertension affects about 22% of Americans between the ages of 18 and 74. Untreated, it poses a severe health risk and is associated with heart disease and stroke. In most patients, hypertension can be controlled with medication.

But uncontrolled hypertension remains a monumental health problem, disproportionately affecting minorities, the poor, people with less formal education and those with limited access to medical care. One of the government’s health goals for the year 2000 is to bring at least 50% of patients with hypertension under control.