Professor Johns Hopkins University School of Medicine Baltimore, United States
Background: Hypertension (HTN) is a major cause of cardiovascular events and death. Timely recognition of incident hypertension is essential to ensure early implementation of treatment.
Objectives: To develop algorithms and identify patients with incident HTN using electronic medical records (EMR) from a large, multi-center health system; and to describe the characteristics of such individuals.
Methods: We extracted EMR data from patients seen at primary care clinics in the Johns Hopkins Health System between April 2013 to December 2016. We included individuals ≥ 18 years old who had 2 or more outpatient visits and office blood pressure (BP) measurements without HTN during the first year of study period. HTN is defined based on at least one of the following criteria: (1) a diagnosis of primary HTN using ICD-9-CM or ICD-10-CM; or (2) prescription of anti-hypertensive medication; or (3) more than 2 consecutive elevated BPs regardless of diagnosis or treatment. We defined elevated BP as systolic blood pressure (SBP) ≥ 130 mm Hg or diastolic blood pressure (DBP) ≥ 80 mm Hg among those older than 79 years old or have diabetes or have chronic kidney disease (CKD), and SBP ≥ 140 mm Hg or DBP ≥ 90 mm Hg among all others. We defined incident HTN as individuals fulfilling the above criteria after April 2014.
Results: A total of 27998 patients (54.3%) met at least one criterion for incident HTN. Of these, 6738 (24.0%) of individuals could be identified with only a diagnosis code; 9275 (33.1%) could be identified with antihypertensive medication use alone; and 22519 (80.4%) could be classified with use of BP measurements. Among 6,738 of incident hypertension patients ascertained by diagnosis code, 55.2% of patients had elevated BPs, yet 50.0% were not started on an anti-hypertensive medicine. Out of 22,519 patients with elevated BPs, 14559 (64.7%) were not diagnosed with HTN nor prescribed medication. Patients with incident HTN had a mean age of 58.0 years (SD, 14.1) and 44.3% were male. The average SBP and DBP of Black patients (38.2%) was 145.5 mm Hg (SD, 16.3) and 86.7 mm Hg (SD, 11.8) while White patients (53.9%) had SBP and DBP of 143.6 mm Hg (SD, 14.6) and 83.5 mm Hg (SD, 11.4). 6.6%, 4.5%, and 1.7% of patients had cardiovascular disease, hyperlipidemia, and CKD diagnoses during baseline period. The mean body mass index was 32.3 kg/m2 (SD, 7.71) and average atherosclerotic cardiovascular disease risk was 12.8% (SD, 11.7).
Conclusions: Among this cohort, hypertension was both common and frequently undiagnosed, and even among those with a coded diagnosis, blood pressure levels were often above target. Further efforts are needed to improve identification and treatment of this common cardiovascular condition.
.jpg "Jodi B. Segal, MD, MPH (she/her/hers) photo")
