Delays in hypertension diagnosis persist despite records of high BP measurement

A recent study has observed delays in hypertension diagnosis, which potentially results in hospital visits and other cardiovascular diagnoses.

A team of investigators obtained data from the electronic health record for University of Iowa Healthcare from 2016 to 2022 for patients with any blood pressure (BP) record of 130/80 mm Hg or greater, but with no initial diagnosis of hypertension.

A Cox proportional hazards model was used to determine the length of diagnostic delay and the risk factors for such delay. Furthermore, the investigators explored the presence of provider notes discussing BP or hypertension.

At their first visit, only 5 percent of patients with BP readings of 130/80 mm Hg or greater received a hypertension diagnosis. At 1 month, 7.4 percent of patients were diagnosed with hypertension. This increased to 10 percent within 3 months and to 14 percent at 12 months. Most individuals remained undiagnosed at 12 months, while 75 percent still had no diagnosis at 5 years.

Shorter diagnostic delays correlated with higher BP values, prior diagnoses of “high BP, not hypertension,” and prior clinical notes discussing BP or hypertension. In addition, shorter delays also showed an association with other cardiovascular diagnoses, primary-care visits, and inpatient stays.

“Our findings highlight the large number of missed opportunities to diagnose hypertension and demonstrate compelling reasons for improving clinical documentation related to high BP readings and increasing primary-care visits,” the investigators said.

“Diagnostic delays contribute to uncontrolled hypertension, leading to increased morbidity, mortality, and costs,” they noted.