The characteristics of the first fifty patients enrolled in the clinic are described in Table 1. The typical patient was a 60-year-old diabetic African-American woman with a history of hypertension for 18 years taking 4 different antihypertensive medications, including a diuretic, calcium-channel blocker, alpha-blocker, and ACE-inhibitor. Of the fifty patients, 33 (66%) were female and 25 (50%) were diabetic.

Table 1. Patient characteristics (n = 50)

The most common reasons for poor blood pressure control were volume overload and poor medication adherence (Table 2). None of the patients had secondary hypertension.
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Figure 1. Initial and final systolic blood pressures for each patient enrolled in the clinic. The circles represent initial systolic blood pressures, and the arrows represent final systolic blood pressures. The horizontal line at 140 mm Hg depicts the target systolic blood pressure for patients without diabetes mellitus. Those with diabetes mellitus had a target systolic blood pressure of 130. Of note, three patients had initial readings at target, though review of medical records revealed uncontrolled blood pressures at previous clinic visits.

Figure 2. Initial and final diastolic blood pressures for each patient enrolled in the clinic. The circles represent initial diastolic blood pressures, and the arrows represent final diastolic blood pressures. The horizontal line at 90 mm Hg depicts the target diastolic blood pressure for patients without diabetes mellitus. Those with diabetes mellitus had a target diastolic blood pressure of 85.

Initial and final systolic and diastolic blood pressures for each patient are shown in Figures 1 and 2. After six months of follow-up, 29 (58%) of the 50 patients had achieved and maintained their target blood pressure and were referred back to their primary physician. The mean duration of time to maintenance of target blood pressure was 3.8 months. Four (8%) patients had improved blood pressure control but had not maintained target levels over two consecutive visits. Six (12%) had not improved, and 11 (22%) were lost to follow-up. The medical interventions are described in Table 3. buy antibiotics amoxicillin

Table 2. Primary cause of difficult-to-control hypertension

When interviewed at 6-months follow-up, over 75% of patients endorsed the following five interventions as being helpful in achieving better blood pressure control: physicians who specialized in the treatment of hypertension, medication changes, education about hypertension, nutrition, and exercise. Of these, there was no agreement on the single most important factor. viagra soft

Table 3. Medication changes in patients who achieved blood pressure control