- Email: [email protected]
Relationship between physician knowledge of hypertension and their collaboration with clinical pharmacists
218A
POSTERS: Patient-Provider-Healthcare System Issues
P-577 CHARACTERISTICS OF PATIENTS PRESENTING TO AN EMERGENCY DEPARTMENT WITH HYPERTENSIVE URGENCIES John D Bisognano, Sabine E Heitz, Seth M Bender. Internal Medicine / Cardiology, University of Rochester Medical Center, Rochester, NY. As many as 3% of emergency department visits are for hypertensive urgencies. The visits are a very costly, inefficient way of treating hypertension. The value of treating urgencies has never rigorously been studied prospectively, as most practitioners simply wish to achieve lowering of “the big numbers.” We retrospectively reviewed emergency department charts of 50 consecutive patients evaluated for hypertensive urgencies. Those with frank emergencies were excluded. Sixty-four percent of the patients were female, 36% presented only with SBP⬎180, 10% only with DBP ⬎110, 36% with both SBP ⬎180 and DBP ⬎110, and 18% with neither SBP⬎180 or DBP⬎110. Twenty-four percent of the patients were less than 40 years of age, 10% in their 40’s, 22% in their 50’s, 28% in their 60’s, and 16% greater than 70. On admission, 32% were on no antihypertensive medication, 24% on one medication, 30% on two medications, 10% on three medications, and 4% were on four or more medications. The most common presenting symptoms were headache (32%) and dizziness (20%), with four percent being asymptomatic. The average emergency department stay was 5 hours. Sixty-two percent of the patients had no contact with a physician during the prior three months, and 26% had not seen a physician during the past year. The majority of patients presenting to the emergency department had not had their blood pressure evaluated during the prior 90 days, and 86% are taking less than 3 anti-hypertensive medications. Many patients are younger than 40 years of age and the leading presenting symptoms are headache and dizziness. The emergency department evaluation and treatment was widely variable, with no clear pattern emerging, including choice of discharge medications. Unlike hypertensive emergencies, where immediate lowering of blood pressure is compulsory, the treatment of hypertensive urgencies has not previously been rigorously examined in a systematic fashion. This database is an important first step that evaluates characteristics of patients presenting to the emergency department for hypertensive urgencies and may identify appropriate clinical targets for aggressive outpatient BP treatment. It can also assist in the development of algorithms for the safe management of this large group of patients and result in substantial cost savings through guidelinedriven optimization of medical therapy. Key Words: Hypertensive Emergency, Hypertensive Urgency, Severe Hypertension
P-578 RELATIONSHIP BETWEEN PHYSICIAN KNOWLEDGE OF HYPERTENSION AND BLOOD PRESSURE CONTROL Barry L. Carter, William R. Doucette, George Bergus, Arthur Hartz, Janyce J. Stewart. Division of Clinical and Administrative Pharmacy, College of Pharmacy, University of Iowa, Iowa City, IA; Department of Family Medicine, College of Medicine, University of Iowa, Iowa City, IA. It is commonly believed that a major reason for poor adherence to hypertension guidelines is insufficient knowledge of the guidelines on the part of physicians. We have developed a knowledge questionnaire (KQ) to examine physician knowledge with JNC-7. The KQ had 35 questions and 5 domains (diagnosis, goals, treatment, monitoring, adverse drug reactions). The objective of the present study was to evaluate the relationship between physician knowledge and blood pressure control in up to 20 randomly selected patients from each physician’s practice. Systolic blood pressures (SBP) were averaged for each physician and the overall 0895-7061/05/$30.00
AJH–May 2005–VOL. 18, NO. 5, PART 2
BP (both SBP and DBP) control rate was calculated for each physician. There were 32 physicians from 2 clinics and 613 patients in the sample. The mean SBP was 140.9 ⫾ 5.6 mm Hg. The percent of patients with controlled BP (both SBP and DBP) was 43% (range 20-80% depending on physician). The mean correct response on the KQ was 70% (range 54-94%). There was a strong inverse relationship between BP control rates and correct responses on the KQ (-0.532, p⫽0.002). There was also a strong correlation between correct responses on the KQ and higher SBP (0.515, p⫽0.003). When examining specific domains in the KQ, only the treatment and adverse drug event domains were significant. The better the score on the treatment domain, the lower the BP control rates (-0.573, p⫽0.0006) and the higher the SBP (0.529, p⫽0.002). The better the score on the adverse reaction domain the lower the BP control rates (-0.439) and the higher the SBP (0.445, p⫽0.011). These findings would imply that higher knowledge of JNC-7, as measured by this tool, is associated with poorer BP control. It is more likely that the explanation for these results is that physician knowledge is a necessary, but not sufficient, factor in achieving good BP control. Other patient factors such as social, economic, demographic variables, or health system barriers, are likely to be far more important predictors of BP control. Additional research should be conducted in larger physician populations to evaluate these relationships. Key Words: Blood Pressure Control, JNC-7, Physician Knowledge
P-579 RELATIONSHIP BETWEEN PHYSICIAN KNOWLEDGE OF HYPERTENSION AND THEIR COLLABORATION WITH CLINICAL PHARMACISTS Barry L. Carter, William R. Doucette, Allan J. Zillich, George Bergus, Arthur Hartz. Division of Clinical and Administrative Pharmacy, University of Iowa, Iowa City, IA; School of Pharmacy, Purdue University, Indianapolis, IN; Department of Family Medicine, University of Iowa, Iowa City, IA. Many family medicine or internal medicine residency programs have clinical pharmacists who assist with education and patient care. These physician/pharmacist teams frequently provide chronic care and improve safety. We have validated an instrument to measure physician collaboration with pharmacists and it includes questions like: “I work with this pharmacist to plan goals of drug therapy,” “Decision making for our patients is coordinated between this pharmacist and me,” and “There is cooperation between this pharmacist and myself in managing drug therapy.” We have also developed a knowledge questionnaire to examine knowledge with JNC-7. The knowledge questionnaire had 35 questions and 5 domains. The purpose of the present study was to evaluate the relationship between physician knowledge of hypertension and their degree of collaboration with pharmacists. There were 55 physicians from 7 different clinics who completed the knowledge questionnaire. The overall correct responses were 68% (range 43-94%). The correct responses in selected knowledge domains were treatment: 65% (35-94%), monitoring: 76% (33-100%) and adverse reactions: 65% (0-100%). There was generally a negative correlation between physician knowledge and collaboration with clinical pharmacists suggesting that physicians with high knowledge may not collaborate as much. This finding occurred for all questions in the knowledge questionnaire (-0.032), or within the treatment (-0.069) or monitoring (-0.180) domains, though none of these were statistically significant. Interestingly, physician’s who scored higher on the adverse reaction domain had higher levels of collaboration with pharmacists (0.313, p⫽0.0299). This pilot study suggests that physicians who collaborate more with clinical pharmacists in their office have higher knowledge scores for adverse drug reactions which may relate to the frequency of teaching related to adverse effects. Additional research should be conducted in larger physician populations to evaluate these relationships. © 2005 by the American Journal of Hypertension, Ltd. Published by Elsevier Inc.
AJH–May 2005–VOL. 18, NO. 5, PART 2
Zillich AJ, McDonough RP, Carter BL, Doucette WR. Influential characteristics of physician/pharmacist collaborative relationships. Ann Pharmacother 2004;38:764-70. Key Words: Physician Collaboration, Physician Knowledge
P-580 THE BURDON OF INSURANCE AND PRIMARY CARE COVERAGE NEEDS IN YOUNG HYPERTENSIVE PATIENTS IDENTIFIED IN THE EMERGENCY DEPARTMENT David M Cline, Carlos M Ferrario, Saheed M Hamdan, Carma Ayala, George A Mensah, Akaki Lekiachvili. Hypertension and Vascular Disease Center, Wake Forest University School of Medicine, WinstonSalem, NC; National Center for Chronic Disease Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Our purpose was to assess the impact of insurance and primary care coverage on different age groups presenting to the emergency department (ED) with hypertension (HTN). Methods: All patients ⬎18 years presenting to our university hospital emergency department were triaged for HTN with the use of a blood pressure measurement protocol. Once identified, all patients with a blood pressure (BP) of 140/90 mm Hg or higher, or a history of hypertension were included for retrospective review. All listed categorical comparisons were tested with Chi-Square or Cochran-Mantel-Haenszel statistic as appropriate, p⬍ 0.001. Results: Among the 9,161 ED patients screened, 4543 (49.6%) had BP ⬎140/90 mm Hg or a history of HTN. In a sub-analysis of the 4,543 patients identified, 47.8% had elevated BP only, 49.7% had elevated BP and a history of HTN, 2.5% had a history of HTN with their BP controlled; 79.4% were insured, 20.6% were self-pay (no insurance). Among the 4,543 patients with elevated BP or a history of HTN, 55.5% of Hispanics were uninsured followed by 25.1% of Blacks, 21.3% of Asians, and 17.1% of Whites. Only 31% of hypertensive self-pay patients had a history of HTN, vs. 58% of insured patients. Self-pay status decreased with rising age (45% for ages 20 to 29 years, 1.0% at ages over 79 years. The lack of primary care coverage also decreased with age, from a high of 48% for ages 20 to 29 years, to a low of 1.0% for ages over 79 years. Fewer hypertensive self-pay patients had a primary care physician, 41.2% vs. 77.8% of insured patients. Conclusions: Young hypertensive patients are more likely to be without health care coverage or providers than older patients. Self-pay status was associated with a lack of a primary health source and was more frequent amongst minorities, especially Hispanics. This ED-based HTN registry provides important information regarding patients at risk for complications of HTN, and could contribute to the elimination of HTNrelated health disparities especially among the uninsured. Moreover, the ED provides an important safety net of care for young hypertensive patients without insurance and no usual source of health care. Key Words: Emergency Department, Primary Care Provider, Self Pay Dtatus
P-581 RELATIONSHIP BETWEEN ERECTILE DYSFUNCTION AND ANTIHYPERTENSIVE MEDICATIONS Tamara S. Evans, Gary W. Buck, Christopher Conner. Clinical Education, Pfizer, Indianapolis, IN; Clinical Education, Pfizer, Schaumburg, IL. Introduction and Objective: The Sexual Health Inventory for Men (SHIM) is a simple validated survey used to screen men for erectile dysfunction (ED). Associations between ED risk factors and SHIM scores were assessed in men not previously treated with ED therapy.
POSTERS: Patient-Provider-Healthcare System Issues
219A
Methods: This analysis combined cross sectional patient surveys with retrospective chart review, using a convenience sample of male respondents age 30 and older. Respondents who volunteered were asked to fill out the SHIM screening tool. Office staff recorded pertinent lab, demographic, and risk factor data from the patient charts. Results: SHIM surveys were completed by 333 men between the ages of 30 and 87. Positive SHIM scores were identified in 55% of the respondents. A correlation was found between ED and advancing age, diabetes mellitus, coronary artery disease, smoking, antidepressant use, and benign prostatic hypertrophy. Although a correlation was not found between SBP and SHIM result, an association was observed between the use of antihypertensive medications and ED (p⫽0.001). Patients receiving antihypertensive medications regardless of antihypertensive class were more likely to have positive SHIM scores than those patients not receiving any antihypertensive medications. An association between two or more antihypertensive medications and ED was observed. Conclusions: A large proportion of men with previously untreated ED were identified in this respondent population. In addition to previously reported risk factors for ED, practitioners should also be aware that patients receiving antihypertensive therapy, particularly more than one antihypertensive medication, should be screened for ED. Parameter
SHIM Positive
SHIM Negative
P value
ACE Inhibitor No Antihypertensive CCB No Antihypertensive Diuretic No Antihypertensive Beta-Blocker No Antihypertensive ARB No Antihypertensive 1 antihypertensive medication 2 or more antihypertensives
41 (75.9%) 100 (49.8%) 20 (76.9%) 100 (49.8%) 25 (75.8%) 100 (49.8%) 33 (68.8%) 100 (49.8%) 28 (70.0%) 100 (49.8%) 35 (58.3%) 48 (77.4%)
13 (24.1%) 101 (50.2%) 6 (23.1%) 101 (50.2%) 8 (24.2%) 101 (50.2%) 15 (31.2%) 101 (50.2%) 12 (30.0%) 101 (50.2%) 25 (41.7%) 14 (22.6%)
P ⫽ 0.001 P ⫽ 0.009 P ⫽ 0.006 P ⫽ 0.018 P ⫽ 0.019 P ⫽ 0.024
Key Words: Antihypertensive Medications, Cardiovascular Disease, Erectile Dysfunction
P-582 FACTORS RELATED TO PATIENT DELAY TIME IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION ST SEGMENT ELEVATION AND ESSENTIAL HYPERTENSION Jincheng Guo, Qi Hua, Dongxia Liu. Cardiology, Beijing Xuanwu Hospital, Beijing, China. Objective: To examine patient delay time(PDT) in seeking treatment among patients with ST-elevation myocardial infarction (STEMI) and essential hypertension and to identify factors influencing PDT. Methods: Patients with STEMI were divided into two groups based on PDT: Short PDT group(PDT ⱕ 60 minutes after onset of symptoms) and Long PDT group (⬎60minutes after symptom onset). A questionnaire developed to assess demographic characteristics,Clinical factors and psychological factors. Paients were interviewed within 72 hours of admission to 2 hospitals. Results: 329 consecutiveconfirmed STEMI patients( Mean age 61years; 72.5% men) with a median PDT of 90min and a prehospital delay time 170min were studied, PDT was less than 1 hours in 47.4% of patients, while more than 1 hours in 52.6% ,In univariate analyses, patients with short PDT were witness onset, progress course of symptom, severe pain, death anxiety, knowing AMI as a deadly disease and its presentation, taking the symptom seriously, and “going quickly” to see the doctor . Patients with longer PDT were age>65year, nocturnal onset, experienced their symptoms at home, gradual onset, “waited to see whether symptoms disappeared”, “worried about troubling others”, “took pain medication” and preinfarction angina. A stepwise multiple regression analysis further suggested the following independent predictors to PDT: took pain medication, wait and see, not wanting to bother anybody,
POSTERS: Patient-Provider-Healthcare System Issues
P-577 CHARACTERISTICS OF PATIENTS PRESENTING TO AN EMERGENCY DEPARTMENT WITH HYPERTENSIVE URGENCIES John D Bisognano, Sabine E Heitz, Seth M Bender. Internal Medicine / Cardiology, University of Rochester Medical Center, Rochester, NY. As many as 3% of emergency department visits are for hypertensive urgencies. The visits are a very costly, inefficient way of treating hypertension. The value of treating urgencies has never rigorously been studied prospectively, as most practitioners simply wish to achieve lowering of “the big numbers.” We retrospectively reviewed emergency department charts of 50 consecutive patients evaluated for hypertensive urgencies. Those with frank emergencies were excluded. Sixty-four percent of the patients were female, 36% presented only with SBP⬎180, 10% only with DBP ⬎110, 36% with both SBP ⬎180 and DBP ⬎110, and 18% with neither SBP⬎180 or DBP⬎110. Twenty-four percent of the patients were less than 40 years of age, 10% in their 40’s, 22% in their 50’s, 28% in their 60’s, and 16% greater than 70. On admission, 32% were on no antihypertensive medication, 24% on one medication, 30% on two medications, 10% on three medications, and 4% were on four or more medications. The most common presenting symptoms were headache (32%) and dizziness (20%), with four percent being asymptomatic. The average emergency department stay was 5 hours. Sixty-two percent of the patients had no contact with a physician during the prior three months, and 26% had not seen a physician during the past year. The majority of patients presenting to the emergency department had not had their blood pressure evaluated during the prior 90 days, and 86% are taking less than 3 anti-hypertensive medications. Many patients are younger than 40 years of age and the leading presenting symptoms are headache and dizziness. The emergency department evaluation and treatment was widely variable, with no clear pattern emerging, including choice of discharge medications. Unlike hypertensive emergencies, where immediate lowering of blood pressure is compulsory, the treatment of hypertensive urgencies has not previously been rigorously examined in a systematic fashion. This database is an important first step that evaluates characteristics of patients presenting to the emergency department for hypertensive urgencies and may identify appropriate clinical targets for aggressive outpatient BP treatment. It can also assist in the development of algorithms for the safe management of this large group of patients and result in substantial cost savings through guidelinedriven optimization of medical therapy. Key Words: Hypertensive Emergency, Hypertensive Urgency, Severe Hypertension
P-578 RELATIONSHIP BETWEEN PHYSICIAN KNOWLEDGE OF HYPERTENSION AND BLOOD PRESSURE CONTROL Barry L. Carter, William R. Doucette, George Bergus, Arthur Hartz, Janyce J. Stewart. Division of Clinical and Administrative Pharmacy, College of Pharmacy, University of Iowa, Iowa City, IA; Department of Family Medicine, College of Medicine, University of Iowa, Iowa City, IA. It is commonly believed that a major reason for poor adherence to hypertension guidelines is insufficient knowledge of the guidelines on the part of physicians. We have developed a knowledge questionnaire (KQ) to examine physician knowledge with JNC-7. The KQ had 35 questions and 5 domains (diagnosis, goals, treatment, monitoring, adverse drug reactions). The objective of the present study was to evaluate the relationship between physician knowledge and blood pressure control in up to 20 randomly selected patients from each physician’s practice. Systolic blood pressures (SBP) were averaged for each physician and the overall 0895-7061/05/$30.00
AJH–May 2005–VOL. 18, NO. 5, PART 2
BP (both SBP and DBP) control rate was calculated for each physician. There were 32 physicians from 2 clinics and 613 patients in the sample. The mean SBP was 140.9 ⫾ 5.6 mm Hg. The percent of patients with controlled BP (both SBP and DBP) was 43% (range 20-80% depending on physician). The mean correct response on the KQ was 70% (range 54-94%). There was a strong inverse relationship between BP control rates and correct responses on the KQ (-0.532, p⫽0.002). There was also a strong correlation between correct responses on the KQ and higher SBP (0.515, p⫽0.003). When examining specific domains in the KQ, only the treatment and adverse drug event domains were significant. The better the score on the treatment domain, the lower the BP control rates (-0.573, p⫽0.0006) and the higher the SBP (0.529, p⫽0.002). The better the score on the adverse reaction domain the lower the BP control rates (-0.439) and the higher the SBP (0.445, p⫽0.011). These findings would imply that higher knowledge of JNC-7, as measured by this tool, is associated with poorer BP control. It is more likely that the explanation for these results is that physician knowledge is a necessary, but not sufficient, factor in achieving good BP control. Other patient factors such as social, economic, demographic variables, or health system barriers, are likely to be far more important predictors of BP control. Additional research should be conducted in larger physician populations to evaluate these relationships. Key Words: Blood Pressure Control, JNC-7, Physician Knowledge
P-579 RELATIONSHIP BETWEEN PHYSICIAN KNOWLEDGE OF HYPERTENSION AND THEIR COLLABORATION WITH CLINICAL PHARMACISTS Barry L. Carter, William R. Doucette, Allan J. Zillich, George Bergus, Arthur Hartz. Division of Clinical and Administrative Pharmacy, University of Iowa, Iowa City, IA; School of Pharmacy, Purdue University, Indianapolis, IN; Department of Family Medicine, University of Iowa, Iowa City, IA. Many family medicine or internal medicine residency programs have clinical pharmacists who assist with education and patient care. These physician/pharmacist teams frequently provide chronic care and improve safety. We have validated an instrument to measure physician collaboration with pharmacists and it includes questions like: “I work with this pharmacist to plan goals of drug therapy,” “Decision making for our patients is coordinated between this pharmacist and me,” and “There is cooperation between this pharmacist and myself in managing drug therapy.” We have also developed a knowledge questionnaire to examine knowledge with JNC-7. The knowledge questionnaire had 35 questions and 5 domains. The purpose of the present study was to evaluate the relationship between physician knowledge of hypertension and their degree of collaboration with pharmacists. There were 55 physicians from 7 different clinics who completed the knowledge questionnaire. The overall correct responses were 68% (range 43-94%). The correct responses in selected knowledge domains were treatment: 65% (35-94%), monitoring: 76% (33-100%) and adverse reactions: 65% (0-100%). There was generally a negative correlation between physician knowledge and collaboration with clinical pharmacists suggesting that physicians with high knowledge may not collaborate as much. This finding occurred for all questions in the knowledge questionnaire (-0.032), or within the treatment (-0.069) or monitoring (-0.180) domains, though none of these were statistically significant. Interestingly, physician’s who scored higher on the adverse reaction domain had higher levels of collaboration with pharmacists (0.313, p⫽0.0299). This pilot study suggests that physicians who collaborate more with clinical pharmacists in their office have higher knowledge scores for adverse drug reactions which may relate to the frequency of teaching related to adverse effects. Additional research should be conducted in larger physician populations to evaluate these relationships. © 2005 by the American Journal of Hypertension, Ltd. Published by Elsevier Inc.
AJH–May 2005–VOL. 18, NO. 5, PART 2
Zillich AJ, McDonough RP, Carter BL, Doucette WR. Influential characteristics of physician/pharmacist collaborative relationships. Ann Pharmacother 2004;38:764-70. Key Words: Physician Collaboration, Physician Knowledge
P-580 THE BURDON OF INSURANCE AND PRIMARY CARE COVERAGE NEEDS IN YOUNG HYPERTENSIVE PATIENTS IDENTIFIED IN THE EMERGENCY DEPARTMENT David M Cline, Carlos M Ferrario, Saheed M Hamdan, Carma Ayala, George A Mensah, Akaki Lekiachvili. Hypertension and Vascular Disease Center, Wake Forest University School of Medicine, WinstonSalem, NC; National Center for Chronic Disease Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Our purpose was to assess the impact of insurance and primary care coverage on different age groups presenting to the emergency department (ED) with hypertension (HTN). Methods: All patients ⬎18 years presenting to our university hospital emergency department were triaged for HTN with the use of a blood pressure measurement protocol. Once identified, all patients with a blood pressure (BP) of 140/90 mm Hg or higher, or a history of hypertension were included for retrospective review. All listed categorical comparisons were tested with Chi-Square or Cochran-Mantel-Haenszel statistic as appropriate, p⬍ 0.001. Results: Among the 9,161 ED patients screened, 4543 (49.6%) had BP ⬎140/90 mm Hg or a history of HTN. In a sub-analysis of the 4,543 patients identified, 47.8% had elevated BP only, 49.7% had elevated BP and a history of HTN, 2.5% had a history of HTN with their BP controlled; 79.4% were insured, 20.6% were self-pay (no insurance). Among the 4,543 patients with elevated BP or a history of HTN, 55.5% of Hispanics were uninsured followed by 25.1% of Blacks, 21.3% of Asians, and 17.1% of Whites. Only 31% of hypertensive self-pay patients had a history of HTN, vs. 58% of insured patients. Self-pay status decreased with rising age (45% for ages 20 to 29 years, 1.0% at ages over 79 years. The lack of primary care coverage also decreased with age, from a high of 48% for ages 20 to 29 years, to a low of 1.0% for ages over 79 years. Fewer hypertensive self-pay patients had a primary care physician, 41.2% vs. 77.8% of insured patients. Conclusions: Young hypertensive patients are more likely to be without health care coverage or providers than older patients. Self-pay status was associated with a lack of a primary health source and was more frequent amongst minorities, especially Hispanics. This ED-based HTN registry provides important information regarding patients at risk for complications of HTN, and could contribute to the elimination of HTNrelated health disparities especially among the uninsured. Moreover, the ED provides an important safety net of care for young hypertensive patients without insurance and no usual source of health care. Key Words: Emergency Department, Primary Care Provider, Self Pay Dtatus
P-581 RELATIONSHIP BETWEEN ERECTILE DYSFUNCTION AND ANTIHYPERTENSIVE MEDICATIONS Tamara S. Evans, Gary W. Buck, Christopher Conner. Clinical Education, Pfizer, Indianapolis, IN; Clinical Education, Pfizer, Schaumburg, IL. Introduction and Objective: The Sexual Health Inventory for Men (SHIM) is a simple validated survey used to screen men for erectile dysfunction (ED). Associations between ED risk factors and SHIM scores were assessed in men not previously treated with ED therapy.
POSTERS: Patient-Provider-Healthcare System Issues
219A
Methods: This analysis combined cross sectional patient surveys with retrospective chart review, using a convenience sample of male respondents age 30 and older. Respondents who volunteered were asked to fill out the SHIM screening tool. Office staff recorded pertinent lab, demographic, and risk factor data from the patient charts. Results: SHIM surveys were completed by 333 men between the ages of 30 and 87. Positive SHIM scores were identified in 55% of the respondents. A correlation was found between ED and advancing age, diabetes mellitus, coronary artery disease, smoking, antidepressant use, and benign prostatic hypertrophy. Although a correlation was not found between SBP and SHIM result, an association was observed between the use of antihypertensive medications and ED (p⫽0.001). Patients receiving antihypertensive medications regardless of antihypertensive class were more likely to have positive SHIM scores than those patients not receiving any antihypertensive medications. An association between two or more antihypertensive medications and ED was observed. Conclusions: A large proportion of men with previously untreated ED were identified in this respondent population. In addition to previously reported risk factors for ED, practitioners should also be aware that patients receiving antihypertensive therapy, particularly more than one antihypertensive medication, should be screened for ED. Parameter
SHIM Positive
SHIM Negative
P value
ACE Inhibitor No Antihypertensive CCB No Antihypertensive Diuretic No Antihypertensive Beta-Blocker No Antihypertensive ARB No Antihypertensive 1 antihypertensive medication 2 or more antihypertensives
41 (75.9%) 100 (49.8%) 20 (76.9%) 100 (49.8%) 25 (75.8%) 100 (49.8%) 33 (68.8%) 100 (49.8%) 28 (70.0%) 100 (49.8%) 35 (58.3%) 48 (77.4%)
13 (24.1%) 101 (50.2%) 6 (23.1%) 101 (50.2%) 8 (24.2%) 101 (50.2%) 15 (31.2%) 101 (50.2%) 12 (30.0%) 101 (50.2%) 25 (41.7%) 14 (22.6%)
P ⫽ 0.001 P ⫽ 0.009 P ⫽ 0.006 P ⫽ 0.018 P ⫽ 0.019 P ⫽ 0.024
Key Words: Antihypertensive Medications, Cardiovascular Disease, Erectile Dysfunction
P-582 FACTORS RELATED TO PATIENT DELAY TIME IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION ST SEGMENT ELEVATION AND ESSENTIAL HYPERTENSION Jincheng Guo, Qi Hua, Dongxia Liu. Cardiology, Beijing Xuanwu Hospital, Beijing, China. Objective: To examine patient delay time(PDT) in seeking treatment among patients with ST-elevation myocardial infarction (STEMI) and essential hypertension and to identify factors influencing PDT. Methods: Patients with STEMI were divided into two groups based on PDT: Short PDT group(PDT ⱕ 60 minutes after onset of symptoms) and Long PDT group (⬎60minutes after symptom onset). A questionnaire developed to assess demographic characteristics,Clinical factors and psychological factors. Paients were interviewed within 72 hours of admission to 2 hospitals. Results: 329 consecutiveconfirmed STEMI patients( Mean age 61years; 72.5% men) with a median PDT of 90min and a prehospital delay time 170min were studied, PDT was less than 1 hours in 47.4% of patients, while more than 1 hours in 52.6% ,In univariate analyses, patients with short PDT were witness onset, progress course of symptom, severe pain, death anxiety, knowing AMI as a deadly disease and its presentation, taking the symptom seriously, and “going quickly” to see the doctor . Patients with longer PDT were age>65year, nocturnal onset, experienced their symptoms at home, gradual onset, “waited to see whether symptoms disappeared”, “worried about troubling others”, “took pain medication” and preinfarction angina. A stepwise multiple regression analysis further suggested the following independent predictors to PDT: took pain medication, wait and see, not wanting to bother anybody,