Abstract WMP36: Management of Hypertension in Primary Care Safety-net Clinics in the United States

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Introduction: Community health centers (CHCs) provide care to a disproportionate share of vulnerable populations who are at highest risk for uncontrolled hypertension. It is unknown how hypertension treatment at CHCs reflects guideline-concordant therapy compared to private practice.

Methods: We used the National Ambulatory Medical Care Surveys (NAMCS) from 2006 to 2010 to examine four guideline-concordant treatment practices in non-pregnant adults with hypertension: Initiation of a new medication for uncontrolled hypertension, use of fixed-dose combination drugs for patients on multiple antihypertensive medications, use of thiazide diuretics among patients with uncontrolled hypertension on ≥3 antihypertensive medications, and use of aldosterone antagonist for resistant hypertension, comparing use at CHCs to private physician’s offices overall and by payer group.

Results: Medicaid patients at CHCs were as likely as privately insured individuals to receive a new medication for uncontrolled hypertension (AOR 1.0, 95% CI 0.6-1.9), while Medicaid patients at private physicians’ offices were less likely to receive a new medication compared to the privately insured (AOR 0.3, 95% CI 0.1-0.6). Use of fixed-dose combination drugs was lower at CHCs (AOR 0.6, 95% CI 0.4 – 0.9). There was no difference in thiazide use (adjusted OR 0.7, 95% CI 0.4 – 1.5). Aldosterone antagonist use in resistant hypertension was extremely low in both settings (< 3%).

Conclusion: Compared to private practice, CHCs are more likely to intensify hypertension treatment for patients with Medicaid but less likely to use fixed-dose combination drugs for patients taking multiple medications. Increasing physician use of fixed-dose combination drugs may be particularly helpful in improving hypertension control at CHCs where there are higher rates of uncontrolled hypertension.

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