Blood pressure control in an inner-city walk-in clinic

Despite improvements in the detection, awareness, and treatment of hypertension (HTN) in the United States, a considerable number of people still have uncontrolled high blood pressure (BP). The purpose of this study was to measure the prevalence of HTN across JNC Stages 1-4 in an inner-city, medical Walk-In Clinic. The clinic serves adult ambulatory patients, of whom 86% are African American, 60% are female, 93% of prescriptions are filled at the hospital pharmacy, and the mean age is 46 years. Over a twelve week period in 1994, we collected a single automated BP reading on all 3,726 patient visits to the clinic between 8 a.m. and 5 p.m. on weekdays. For purposes of this study, we defined HTN as a reading above 140/90 or a patient with a BP < 140/90 who filled a prescription for an antihypertensive medication in the last 12 months. We reviewed the hospital computerized prescription profile for all patients with BP < 140/90 to determine which patients with BP < 140/90 had filled prescriptions for BP medications. In the table below, Group A is defined to represent hypertensives with a BP < 140/90 who have received an antihypertensive medication in the last year, and those with an elevated BP (BP ≥ 140/90). Group B includes all patients with a normal BP (BP <: 140/90) who did not have a BP medication prescription on their pharmacy profile. Of the 3,726 patients, 55% (2,057) were in Group A and 45% (1,669) were in Group B. giving a clinic prevalence of 55% for patients with hypertension. Of the hypertensive patients, only 13% were controlled (< 140/90), and 49%, 27%. 13%, and 2% were In JNC V Stages 1, 2, 3, and, 4, respectively. Total < 140/90 Stage 1 Stage 2 Stage 3 Stage 4 A 2,057 265 (13%) 1,005 (49%) 463 (23%) 275 (13%) 49 (2%) B 1,669 1.669 N/A N/A N/A N/A We conclude that in patients with elevated blood pressure seen in a non-appointment clinic, few have controlled BP, and that a significant number have a BP in the range of Stage 3 or 4 hypertension. Aggressive interventions must be designed to increase control of blood pressure in an inner-city population.