Non-PCP blood pressure screens lead to more diagnoses, better management

Expanding blood pressure screenings to non-primary care settings can help identify more patients with high blood pressure (hypertension), and could contribute to better hypertension control and management, according to a Kaiser Permanente study published in The Journal of Clinical Hypertension.

Researchers examined the electronic health records of 1,076,000 Kaiser Permanente Southern California patients seen over a two-year period in primary care settings and non-primary care settings, including optometry, orthopedics, and urology. Of  the patients studied, 112,000 were found to have high blood pressure. The study found that nearly 20% of the newly discovered hypertensive patients were discovered in specialty care rather than primary care venues.

The study reported the prevalence of hypertension and compared the characteristics of those patients identified with hypertension in a non-primary care setting to those identified in primary care settings. Of the patients studied, 112,000 were found to have high blood pressure by the end of the two-year study period. Of these, 83% were diagnosed in a primary care setting and 17% in a non-primary care setting. The main non-primary care specialties to first identify a high blood pressure reading were ophthalmology/optometry with 25%, neurology with 19%, and dermatology with 13%. All staff members conducting blood pressure screenings in these clinical settings were certified in blood pressure measurement to ensure consistency in screenings.

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According to the researchers, the number of “false positives” was comparable between both settings, suggesting that blood pressure readings in non-primary care settings were as accurate as those taken in primary care settings. Patients who were screened in non-primary care settings and found to have high blood-pressure readings were sent back for follow-up visits with their primary care provider.

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The study indicated that patients identified with hypertension during non-primary care visits were more likely to be older, male, and non-Hispanic white. In addition, these patients were also more likely to smoke and to have chronic kidney disease. Researchers also found that patients with an initial high blood pressure identified during non-primary care were less likely to be obese compared to those with an initial high blood pressure identified during a primary care visit.

“A strategy where blood pressures are routinely taken in non-primary care venues such as ophthalmology and  neurology can be effective in diagnosing previously undetected hypertension, and, once identified, effective hypertension control can be achieved,” says study lead author and hypertension lead Joel Handler, M.D., Southern California Kaiser Permanente Hypertension Lead. “The long-term consequences of effective blood pressure control are reductions in heart attacks, strokes, and kidney failure.”

Physicians cannot treat and control hypertension in patients for whom hypertension remains occult, according to Dr. Handler.

High blood pressure is a common and dangerous condition that affects approximately one in three adults, or 67 million people, in the U.S., according to the Centers for Disease Control and Prevention. The CDC estimates that only about half of people with hypertension have their condition under control. High blood pressure, which often has no warning signs or symptoms, increases the risk for heart disease and stroke, two of the leading causes of death for Americans. National surveys indicate that 20% of patients with hypertension are unaware.

“A strategy of routinely performing blood pressure measurements in patients with appointments in nonprimary care clinics represents an efficient means of identifying previously undetected hypertension,” Dr. Handler says. “Detection, treatment, and control of hypertension prevents heart attacks, strokes, and kidney failure. Detection comes first.”

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Although the researchers did not evaluate specific drugs during this study, Kaiser Permanente has adopted an effective hypertension treatment algorithm based on a single pill fixed-dose combination drug which has been associated with control rates exceeding 80%, according to Dr. Handler

This research is part of Kaiser Permanente’s continuing efforts to address the impacts of hypertension and improve the cardiovascular health of its members and the community. In August, a Kaiser Permanente study found that both overtreatment and undertreatment of patients with high blood pressure was linked to kidney failure and death. And last year, researchers announced that Kaiser Permanente Northern California nearly doubled the rate of blood pressure control among adult members with diagnosed hypertension between 2001 and 2009 through one of the largest, community-based hypertension programs in the nation.