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

and treatment patterns before and after the publication of JNC 7. Methods: This was a retrospective, time series analysis of 27 provider groups and managed care or-ganizations from 1998 through 2006. Patients with hypertension were identified from more than 4000 physicians. Medical charts were collected and clinical data were evaluated using prevailing JNC criteria during the time period before and after JNC 7. Results: A total of 19,258 patients were identified with hypertension: 15,258 included in the before-JNC 7 cohort and 4,000 in the after-JNC 7 cohort. BP control in the before-JNC 7 cohort was 40.8 % com-pared with 49.3 % in the after-JNC 7 cohort (P <.0001). After controlling for demographic and clinical covariates, patients in the before-JNC 7 cohort were 45 % less likely to achieve BP control compared with the after-JNC 7 cohort (odds ratio, 0.551; P <.0001). Conclusion: Although findings indicate BP control is improving, a significant need for further im-provement remains. (J Am Board Fam Med 2008;21:512–21.) Hypertension is a prevalent medical condition that affected nearly 1 in 3 adults (72 million) in the United States in 2004.1 Termed “the silent killer” because of its asymptomatic nature, hypertension contributed to approximately 54,186 deaths in 2004 and is expected to result in $69.4 billion in direct and indirect costs in 2008.1 Because hypertension is a precursor to multiple disease conditions, maintaining blood pressure (BP) control and adherence to goals are imperative to re-ducing morbidity and mortality, especially in patients with high risk.2,3 Since its first report in 1977, th