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Frequency of Hypertension in Patients With Gout

      To the Editor: The study by Sarawate et al
      • Sarawate CA
      • Brewer KK
      • Yang W
      • et al.
      Gout medication treatment patterns and adherence to standards of care from a managed care perspective.
      on gout management and treatment patterns published in the July 2006 issue of Mayo Clinic Proceedings highlights important issues for the treatment of gout and many other chronic diseases. However, their finding of a low frequency of hypertension in their gout population (39.8%) is, as they noted, unusual. In comparison, Riedel et al
      • Riedel AA
      • Nelson M
      • Joseph-Ridge N
      • Wallace K
      • MacDonald P
      • Becker M
      Compliance with allopurinol therapy among managed care enrollees with gout: a retrospective analysis of administrative claims.
      reported a frequency of 60.9%. Sarawate et al attributed this difference possibly to the requirement of both an International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) code of 401 for hypertension and an antihypertensive medication claim in their study. Riedel et al did not state their criteria for hypertension.
      Sarawate et al used the Deyo-Charlson Comorbidity Index to determine the baseline chronic disease burden in their gout cohort.
      • Riedel AA
      • Nelson M
      • Joseph-Ridge N
      • Wallace K
      • MacDonald P
      • Becker M
      Compliance with allopurinol therapy among managed care enrollees with gout: a retrospective analysis of administrative claims.
      • Deyo RA
      • Cherkin DC
      • Ciol MA
      Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases.
      Neither Deyo et al
      • Deyo RA
      • Cherkin DC
      • Ciol MA
      Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases.
      nor Charlson et al
      • Charlson ME
      • Pompei P
      • Ales KL
      • MacKenzie CR
      A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.
      addressed hypertension as a comorbid condition or the ICD-9-CM codes used for hypertension.
      I suggest that a second possible explanation for the unusually low frequency of hypertension in patients with gout in the study by Sarawate et al is the exclusion of ICD-9-CM codes 402.xx through 405.xx. These codes include combinations of hypertensive heart and/or renal disease that may be used instead of 401.x, the codes for essential hypertension. Furthermore, the 405.xx codes probably should have been included since that range includes renovascular hypertension.
      These factors do not negate the important contribution by Sarawate et al. However, they may help explain the unusually low frequency of hypertension in their patients with gout.

      REFERENCES

        • Sarawate CA
        • Brewer KK
        • Yang W
        • et al.
        Gout medication treatment patterns and adherence to standards of care from a managed care perspective.
        Mayo Clin Proc. 2006; 81: 925-934
        • Riedel AA
        • Nelson M
        • Joseph-Ridge N
        • Wallace K
        • MacDonald P
        • Becker M
        Compliance with allopurinol therapy among managed care enrollees with gout: a retrospective analysis of administrative claims.
        J Rheumatol. 2004; 31: 1575-1581
        • Deyo RA
        • Cherkin DC
        • Ciol MA
        Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases.
        J Clin Epidemiol. 1992; 45: 613-619
        • Charlson ME
        • Pompei P
        • Ales KL
        • MacKenzie CR
        A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.
        J Chronic Dis. 1987; 40: 373-383

      Linked Article

      • Frequency of Hypertension in Patients With Gout–Reply–I
        Mayo Clinic ProceedingsVol. 81Issue 11
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          Dr Woodard's comments regarding the unusually low prevalence of hypertension in our patients with gout are insightful. We attributed the low prevalence to the stringency of our definition of hypertension (requirement of diagnosis and treatment). As Dr Woodard noted, the low prevalence could be compounded further by the exclusion of ICD-9-CM codes (402.xx through 405.xx) pertaining to hypertensive complications. However, a study evaluating the sensitivity and specificity of identifying hypertension from an administrative claims database suggests that our definition of hypertension (medical claim plus pharmacy claim) has fairly acceptable sensitivity and specificity in identifying truly hypertensive patients.
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