Authors: Rhoades DA, Buchwald D
Publication Year: 2003
Last Updated: 2010-01-21 08:14:08
Journal: Journal of the American Geriatrics Society
Keywords: Indians; North American; Alaskan Natives; hypertension; quality of care; aged; urban; Pacific Northwest; obesity; diabetes mellitus; depression; heart disease; renal disease; diuretics; beta-blockers; serum cholesterol; creatinine; retinal screening; urinalyses; electrocardiograms; life-style modification counseling;
OBJECTIVES: To examine hypertension and its management in a population of older urban American Indians and Alaska Natives (AI/ANs).
Abstract: OBJECTIVES: 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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Funding: Grants P30AG/15297 and P30AG/15292 from the National Institute of Aging and the National Institute of Nursing Research, National Institutes of Health; P01 HS10854 from the Agency for Healthcare Resear