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Better diagnosis, management, and monitoring of hypertension is needed for older American Indians and Alaskan Natives

The number of older American Indians (AIs) and Alaska Natives (ANs) is expected to nearly double between 2000 and 2020, with nearly half of those aged 60 and older living in off-reservation urban areas. Yet few studies have examined the health and quality of health care of older AI/ANs in urban, nonreservation areas. The first and largest study of hypertension among older AI/ANs living in urban areas underscores the need for better diagnosis, management, and monitoring of hypertension and its complications (for example, kidney disease). In the study, which was supported in part by the Agency for Healthcare Research and Quality (HS10854), Dorothy A. Rhoades, M.D., M.P.H., and Dedra Buchwald, M.D., of the University of Colorado Health Sciences Center, studied the medical records of 524 AI/ANs aged 50 and older who were seen at an urban health clinic in the Pacific Northwest between 1994 and 1995.

The researchers examined the frequency of diagnosed hypertension, undiagnosed hypertension, and coexisting conditions, as well as hypertension treatment, control, and quality of care. Over one-third (38 percent) of AI/ANs seen at the clinic had diagnosed hypertension. However, because 23 percent of those without a diagnosis of hypertension had two or more elevated blood pressure measurements during clinic visits, the prevalence of total possible hypertension may have been as high as 52 percent.

Eighty-one percent of diagnosed patients were treated with medication. Although treatment rates were high, blood pressure control was suboptimal. Blood pressure was well controlled in only 37 percent of patients, with men being less well controlled than women. Results showed moderate to high performance rates for screening tests for hypertension-related complications, especially among patients with more diagnosed health problems. Serum cholesterol, creatinine, and retinal screening were performed more often than urinalyses or electrocardiograms. Lifestyle modification counseling was uncommon.

See "Hypertension in older urban Native-American primary care patients," by Drs. Rhoades and Buchwald, in the June 2003 Journal of the American Geriatric Society 51, pp. 774-781.

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