Online Staff Report
MADISON, Wis. — Primary-care doctors are slow to prescribe antihypertensive medication to young adults (ages 18-39) even after an average of 20 months of high blood pressure, according to a new study by researchers at University of Wisconsin School of Medicine and Public Health.
The study, which appears in the Journal of General Internal Medicine, also found that white male young adults who are neither on Medicaid nor frequent patients at the clinic are also less likely to receive medication.
“Our findings highlight the need for system-wide health care interventions tailored to improve cardiovascular preventive services in young adult populations,” said Dr. Heather Johnson, assistant professor of medicine at UW School of Medicine and Public Health. “Of the young adults we studied, more than half continued to have elevated blood pressures even after multiple follow-up clinic visits with their physician. These results strongly suggest that this population, in particular, would benefit from visits that focus on lifestyle modifications and, if indicated, guideline-based blood pressure medication.”
Johnson’s team analyzed the records of more than 10,000 adults, ages 18 years and older, who visited a large, Midwestern practice between 2008 and 2011.
The study included the following results:
• Doctors were 44 percent slower in starting young adults (between the ages of 18 and 39 years old) on hypertension medication than they were for people ages 60 and older.
• Males had a 36 percent slower rate of first receiving antihypertensive medication than women, while white patients were also less likely to receive such treatment.
• Diabetic patients across all ages were started on relevant treatment 56 percent faster than others.
One in every 10 Americans between the ages of 18 and 39 years old suffers from hypertension, and young adults with uncontrolled hypertension are at much higher risk for both chronic kidney disease and premature strokes, particularly in the presence of diabetes. Experts believe that number will likely increase because of high obesity rates.
Johnson said she was surprised by how many other cardiovascular risk factors young adults in the study had. In addition to hypertension, they included obesity, tobacco use and lipid disorders.
“Although young adults are generally considered healthier than older populations, our results highlight the prevalence of multiple risk factors, further underscoring the need for early assessment, education and possible medical intervention in younger adults,” Johnson said.
Previous studies have shown that medication can help control hypertension among young adults better and faster than is the case for older adults. Johnson calls for guideline-based treatment for all ethnic groups and genders and says such interventions should address both bio-behavioral risk factors for hypertension (such as body mass index, exercise and tobacco use) and, when indicated, the initiation of antihypertensive medication.
UW Health recently opened a new Advanced Hypertension Clinic for those whose high blood pressure is difficult to manage. Care is delivered by a multi-disciplinary team of physicians working with a team of nurses, nutritionists, exercise physiologists and a psychologist that specialize in the diagnosis and treatment of hypertension and the prevention of heart, blood vessel and kidney disease. Johnson says the clinic is an important prevention tool designed to keep entire populations of people healthy.
Johnson is supported by a National Institutes of Health (NHLBI) K23 Career Development Award. This study was also supported, in part, through a grant from the Center for Advancing Translational Sciences at the National Institutes of Health (Award UL1RR025011). Additional funding for the study was provided by the University of Wisconsin Health Innovation Program, the Wisconsin Partnership Program, and the Centennial Scholars Program at the UW School of Medicine and Public Health.
Posted June 18, 2014