Kay McMahon | PubMed Health

PubMed2003

Factors associated with uncontrolled hypertension in an affluent, elderly population.

OBJECTIVE: To explore demographic, economic, and treatment-related associations with uncontrolled hypertension in a relatively affluent, community-dwelling population. METHODS: Two home surveys of 655 and 432 subjects with a diagnosis of hypertension were completed in 1995 and 1999, respectively. Trained surveyors recorded medication history plus demographic and socioeconomic variables, as well as several measurements of blood pressure in the home. Uncontrolled hypertension was defined according to guidelines set forth by the Sixth Report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Odds ratios for observing an elevated blood pressure given the patients' medication history, income, insurance coverage, demographic variables, and concomitant disease were estimated using multivariable logistic regression. RESULTS: On both occasions, >60% of the study population had an average blood pressure that was above recommended levels. Diuretic therapy alone (1995 survey) or in combination with an angiotensin-converting enzyme inhibitor (1999 survey) decreased the odds ratio for uncontrolled hypertension by 39% (p = 0.027) and 62% (p = 0.005), respectively. Lack of prescription drug insurance and a history of arthritis had negative effects, increasing the odds ratio for uncontrolled hypertension by more than twofold (p < 0.05). CONCLUSIONS: Uncontrolled hypertension occurs commonly among elderly patients notwithstanding a relatively high standard of living. The choice of medication, presence of concomitant disease, and availability of insurance may be important factors influencing blood pressure control.

Aged↗

PubMed2002

Using correspondence analysis in pharmacy practice.

Correspondence analysis (CA) and some of its uses in pharmacy practice are described. CA is a multivariate and graphic form of exploratory data analysis that reduces a multidimensional contingency table to a two-dimensional plot with minimal loss of information. An exploratory association between medication use and the number and severity of falls among the elderly living at home is used to illustrate the process of CA. Row profiles are constructed by dividing the count data in each cell by the total of the corresponding row, converting frequency data into relative frequencies. A graph of the data can be made by recalculating the frequencies to illustrate how the data might appear in a three-dimensional space with the axes defined by the three categories of falling (minimum, moderate, and major). For example, the number of patients using central nervous system (CNS) agents is plotted using the relative frequencies as vectors to locate a position in the three-dimensional space. All drug profiles and the average profile will lie exactly in a triangular plane defined by the terminal points of each axis. In this manner, data with three dimensions can be projected onto a two-dimensional space. Transferring the vectors named by pharmacologic class onto the plot requires creating two axes that cross at a common point or the origin. This point locates the average profile and defines an important reference for making comparisons. CA revealed that CNS agents may be associated with moderate to major falls, psychotherapeutic agents with moderate falls, and anticoagulants with moderate to minimum falls. CA has widespread uses in pharmacy practice. It can identify patients at risk for serious but preventable drug-related complications, enabling pharmacists to allocate pharmacy resources to the areas in most need and suggest hypotheses for future research. Clinicians can also use CA to analyze vast amounts of patient-related data to uncover hard-to-detect associations. The use of CA in pharmacy practice will allow new strategies for improved patient care to be more readily appreciated and implemented.

Accidental Falls↗