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Research ArticleOriginal Research

Blood Pressure Control and Pharmacotherapy Patterns in the United States Before and After the Release of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) Guidelines

James H. Jackson, John Sobolski, Russ Krienke, Ken S. Wong, Feride Frech-Tamas and Brian Nightengale
The Journal of the American Board of Family Medicine November 2008, 21 (6) 512-521; DOI: https://doi.org/10.3122/jabfm.2008.06.080025
James H. Jackson
PharmD, MPH
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John Sobolski
MD, PhD
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Russ Krienke
MD
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Ken S. Wong
PharmD
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Feride Frech-Tamas
PharmD, MPH
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Brian Nightengale
PhD
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Article Figures & Data

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  • Figure 1.
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    Figure 1.

    Classification of diastolic and systolic blood pressure according to JNC Guidelines 1 to 7.

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    Figure 2.

    Recommended angiotensin converting enzyme inhibitor, angiotensin II receptor blocker, and beta-blocker use in patients with compelling indications.

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    Figure 3.

    Blood pressure control as defined by prevailing criteria.

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    Figure 4.

    Blood pressure control by patient characteristics.

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    Figure 5.

    Blood pressure control over time (prevailing JNC guidelines). N = total sample size during time point of interval.

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    Table 1.

    Demographic Characteristics

    Before-JNC 7 Cohort (n = 15,258)After-JNC 7 Cohort (n = 4000)P
    Gender (n [%])
        Female8442 (55.3)2390 (59.8)<.0001
        Male6777 (44.4)1610 (40.2)
        Not indicated39 (0.3)0 (0.0)
    Race (n [%])
        White4444 (29.1)1484 (37.1) <.0001
        African-American924 (6.0)876 (21.9)
        Hispanic269 (1.8)119 (3.0)
        Asian135 (0.9)25 (0.6)
        Other72 (0.5)11 (0.3)
        Not indicated9414 (61.7)1485 (37.1)
    Age, years (n [%])
        18–441223 (8.0)383 (9.6)<.0001
        45–543528 (23.1)746 (18.6)
        55–644313 (28.3)940 (23.5)
        65–743414 (22.4)834 (20.9)
        75+2763 (18.1)1097 (27.4)
        Mean (SD)61.6 (12.8)63.9 (14.6)<.0001 (unpaired t test)
        Not indicated17 (0.1)0 (0.0)
    Body Mass Index
        Mean (SD)31.0 (6.9)30.7 (6.97).1038 (unpaired t test)
        Not indicated10,174 (66.7)1021 (25.5)
    Geographic Distribution (n [%])
        Region 1 (Northeast)4364 (28.6)984 (24.6)
        Region 2 (Midwest)2755 (18.1)1015 (25.4)
        Region 3 (South)5847 (38.3)1000 (25.0)
        Region 4 (West)2292 (15.0)1001 (25.0)
    • View popup
    Table 2.

    Comorbid Conditions and Cardiovascular Risk Factors

    Presence of Comorbid Conditions and Cardiovascular Risk FactorsBefore-JNC 7 Cohort n = 15,258 (n [%])After-JNC 7 Cohort n = 4000 (n [%])P
    Age (years)*7726 (50.8)†2246 (56.2)<.0001
    Angina1739 (11.4)796 (19.9)<.0001
    CABG1582 (10.4)296 (7.4)<.0001
    Cigarette smoking3006 (19.7)551 (13.8)<.0001
    Diabetes3369 (22.1)1481 (37.0)<.0001
    Family history of CVD3545 (25.1)‡1805 (45.1)<.0001
    Heart failure692 (4.5)310 (7.8)<.0001
    Hyperlipidemia7882 (53.0)§2646 (66.2)<.0001
    Left ventricular hypertrophy524 (3.7)‖377 (9.4)<.0001
    Nephropathy390 (2.8)¶207 (10.3)#<.0001
    Obese2542 (50.0)**1433 (48.1)††.1092
    PAD614 (4.0)234 (5.9)<.0001
    Previous MI876 (5.7)387 (9.7)<.0001
    Retinopathy270 (2.0)‡‡149 (3.7)<.0001
    Stroke880 (5.8)266 (6.7).0392
    • Because of the retrospective, naturalistic design of this study, some data elements were either not available or unable to be determined from the chart reviews. In those cases, the missing values were not included in the denominator of the above percentages. The frequency of this missing information (thus, the number subtracted from the denominator) is as follows:

    • † 51

    • ‡ 1116

    • § 389

    • ‖ 1116

    • ¶ 1505

    • # 1988

    • ** 10174

    • †† 1021

    • ‡‡ 1505.

    • * >55 for men and >65 for women.

    • CABG, coronary artery bypass graft; CVD, cardiovascular disease; PAD, peripheral artery disease; MI, myocardial infarction.

    • View popup
    Table 3.

    Prescribing Patterns

    Before-JNC 7 Cohort (n = 15,258)After-JNC 7 Cohort n = 4,000P
    Number of agents (n [%])
        No drug therapy908 (6.7)249 (6.2)<.0001
        Monotherapy6196 (45.4)1365 (34.1)
        Dual therapy4283 (31.4)1425 (35.6)
        Triple+ therapy2251 (16.5)961 (24.0)
    Class of agents used in patients receiving therapy (n [%])n = 14,350†n = 3751
        Beta-blockers3739 (29.4)1340 (35.7)<.0001
        ACE inhibitors4248 (33.4)1229 (32.7)
        Calcium channel blockers3644 (28.6)967 (25.8)
        ARBs1033 (8.1)508 (13.5)<.0001
        Diuretics–total3950 (31.0)1522 (40.6)<.0001
            Thiazide889 (7.0)748 (19.9)<.0001
            Nonthiazide3061 (24.0)774 (20.6)
        Alpha-blockers708 (5.6)259 (6.9).0020
        Fixed-dose combination agents*1516 (11.9)783 (20.8)<.0001
    • * Fixed-dose combination agents included ACE inhibitor/calcium channel blocker, ACE inhibitor/diuretic, ARB/diuretic, beta-blocker/diuretic, or vasodilator/diuretic.

    • † Includes patients’ prescribed antihypertensive therapy.

    • ACE, angiotensin converting enzyme; ARB, angiotensin II receptor blocker.

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The Journal of the American Board of Family Medicine: 21 (6)
The Journal of the American Board of Family Medicine
Vol. 21, Issue 6
November-December 2008
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Blood Pressure Control and Pharmacotherapy Patterns in the United States Before and After the Release of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) Guidelines
James H. Jackson, John Sobolski, Russ Krienke, Ken S. Wong, Feride Frech-Tamas, Brian Nightengale
The Journal of the American Board of Family Medicine Nov 2008, 21 (6) 512-521; DOI: 10.3122/jabfm.2008.06.080025

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Blood Pressure Control and Pharmacotherapy Patterns in the United States Before and After the Release of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) Guidelines
James H. Jackson, John Sobolski, Russ Krienke, Ken S. Wong, Feride Frech-Tamas, Brian Nightengale
The Journal of the American Board of Family Medicine Nov 2008, 21 (6) 512-521; DOI: 10.3122/jabfm.2008.06.080025
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