AHRQ Study: Hypertension Is Not Diagnosed or Treated Half the Time

In an AHRQ-funded study, about half of patients with diabetes remained undiagnosed and untreated for hypertension even when their blood pressure rate was recorded at a high level. The retrospective study was based on the electronic health records of more than 770 adult patients at a large Midwestern group practice from 2008 to 2011. The study used two blood pressure measurement levels, 130/80 mmHg and 140/90 mmHg, to identify cases of hypertension; normal blood pressure is considered a rate of less than 120/80 mmHg. For patients meeting the 130/80 mmHg level, only 41 percent received a diagnosis for hypertension, and 37 percent received medication. Even at the higher 140/90 mmHg level, only 52 percent of patients received a diagnosis and 49 percent received medication. Future interventions should target patients with multiple comorbidities to improve hypertension and diabetes care, the study concluded. “Diagnosis and Treatment of Incident Hypertension Among Patients with Diabetes: A U.S. Multi-Disciplinary Group Practice Observational Study” and abstractappeared in the June 2015 issue of the Journal of General Internal Medicine.

2015 Jun;30(6):768-76. doi: 10.1007/s11606-015-3202-0.

Diagnosis and treatment of incident hypertension among patients with diabetes: a U.S. multi-disciplinary grouppractice observational study.

Wallace ML1, Magnan EM, Thorpe CT, Schumacher JR, Smith MA, Johnson HM.

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Abstract

BACKGROUND:

Early hypertension control reduces the risk of cardiovascular complications among patients with diabetes mellitus. There is a need to improve hypertension management among patients with diabetes mellitus.

OBJECTIVE:

We aimed to evaluate rates and associations of hypertension diagnosis and treatment among patients with diabetes mellitus andincident hypertension.

DESIGN:

This was a 4-year retrospective analysis of electronic health records.

PARTICIPANTS:

Adults ≥ 18 years old (n = 771) with diabetes mellitus, who met criteria for incident hypertension and received primary care at a large, Midwestern academic group practice from 2008 to 2011 were included

MAIN MEASURES:

Cut-points of 130/80 and 140/90 mmHg were used to identify incident cases of hypertension. Kaplan-Meier analysis estimated the probability of receiving: 1) an initial hypertension diagnosis and 2) antihypertensive medication at specific time points. Cox proportional-hazard frailty models (HR; 95 % CI) were fit to identify associations of time to hypertension diagnosis and treatment.

KEY RESULTS:

Among patients with diabetes mellitus who met clinical criteria for hypertension, 41 % received a diagnosis and 37 % received medication using the 130/80 mmHg cut-point. At the 140/90 mmHg cut-point, 52 % received a diagnosis and 49 % received medication. Atrial fibrillation (HR 2.18; 1.21-4.67) was associated with faster diagnosis rates; peripheral vascular disease (HR 0.18; 0.04-0.74) and fewer primary care visits (HR 0.93; 0.88-0.98) were associated with slower diagnosis rates. Atrial fibrillation (HR 3.07; 1.39-6.74) and ischemic heart disease/congestive heart failure (HR 2.16; 1.24-3.76) were associated with faster treatment rates; peripheral vascular disease (HR 0.16; 0.04-0.64) and fewer visits (HR 0.93; 0.88-0.98) predicted slower medication initiation. Diagnosis and treatment of incident hypertension were similar using cut-points of 130/80 and 140/90 mmHg.

CONCLUSIONS:

Among patients with diabetes mellitus, even using a cut-point of 140/90 mmHg, approximately 50 % remained undiagnosed and untreated for hypertension. Future interventions should target patients with multiple comorbidities to improve hypertension and diabetes clinical care.