Current practice of usual clinic blood pressure measurement in people with and without diabetes: a survey and prospective ‘mystery shopper’ study in UK primary care

Stevens, Sarah; McManus, Richard J; Stevens, Richard

doi:10.1136/bmjopen-2017-020589

Cited by 13 publications

(11 citation statements)

References 32 publications

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“…Generally, patients with more healthcare encounters and/or chronic diseases are more likely to have their BP measured and recorded. [17][18][19][20] The incomplete information on blood pressure values in the electronic healthcare records in our study was consistent with other reports. [21][22][23][24] All four countries included in this study have guidelines recommending regular blood pressure measurements for chronic diseases such as diabetes and cardiovascular disease.…”

Section: Discussionsupporting

confidence: 91%

<p>Evaluating the Effectiveness of an Additional Risk Minimization Measure to Reduce the Risk of Prescribing Mirabegron to Patients with Severe Uncontrolled Hypertension in Four European Countries</p>

Heintjes¹,

Bezemer²,

Prieto-Alhambra³

et al. 2020

CLEP

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Background: Mirabegron, indicated for the treatment of overactive bladder, is contraindicated in patients with severe uncontrolled hypertension (systolic blood pressure ≥180 mm Hg and/or diastolic blood pressure ≥110 mm Hg). In September 2015, a Direct Healthcare Professional Communication (DHPC) letter was disseminated as an additional risk minimisation measure. Purpose: To assess the effectiveness of the DHPC in reducing the proportions of patients with severe or non-severe uncontrolled hypertension at mirabegron initiation. Methods: An observational multi-database cohort study was undertaken using routinely collected healthcare data (December 2012-December 2016) from the PHARMO Database Network (Netherlands), SIDIAP database (Spain), CPRD (United Kingdom, UK) and national healthcare registers and electronic medical records from Finland. DHPC effectiveness was evaluated using interrupted time series analyses comparing trends and changes in monthly proportions of severe or non-severe uncontrolled hypertensive mirabegron initiations relative to the timing of the DHPC dissemination. Results: The study population comprised 52,078 patients. Prior to DHPC dissemination, across the four databases, 0.3-1.3% had severe uncontrolled hypertension. Estimated absolute changes (EAC) in proportions of severe uncontrolled hypertension post-DHPC indicated a tendency towards a lower proportion in the Netherlands (EAC −0.36%, p=0.053), unchanged proportions in Spain and the UK and a higher proportion in Finland (EAC +0.73%, p=0.016). For non-severe uncontrolled hypertension (13-16% pre-DHPC), post-DHPC proportions tended to be lower in the Netherlands (EAC −2.02%, p=0.038) and Spain (EAC −1.04%, p=0.071), and unchanged in the UK and Finland. Conclusion: Severe uncontrolled hypertension prior to mirabegron initiation was uncommon in these four European countries even before DHPC dissemination. This suggests that other risk minimisation communications (prior to the DHPC dissemination) had worked adequately with respect to minimising mirabegron use among patients with severe uncontrolled hypertension. No strong and consistent evidence of further risk minimisation after the DHPC dissemination was observed in this study.

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Section: Discussionsupporting

confidence: 91%

<p>Evaluating the Effectiveness of an Additional Risk Minimization Measure to Reduce the Risk of Prescribing Mirabegron to Patients with Severe Uncontrolled Hypertension in Four European Countries</p>

Heintjes¹,

Bezemer²,

Prieto-Alhambra³

et al. 2020

CLEP

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“…An online survey, which was conducted by The College of Family Physicians of Canada and involved 774 family physicians (response rate, 16.2%), found that AOBP was a common method to screen (42.9%), diagnose (31.1%), and manage (59.2%) HT, while ABPM was reported as the primary diagnostic tool for HT by 14.4% of the respondents (18). A recent study in the United Kingdom (UK) surveying 489 patients, who selfreported to have BP measured during their last clinic visit, found that only one BP reading was obtained in 286 (59.6%) patients (25). Considering the findings of the UK study, around 70% of doctors in our study obtained more than 1 clinic reading when manual BP measurement was used, which was higher than the UK study (25).…”

Section: Discussioncontrasting

confidence: 62%

Preference of blood pressure measurement methods by primary care doctors in Hong Kong: A cross-sectional survey

Lee

Choi

Liu

et al. 2020

Preprint

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Background Hypertension is the most common chronic disease and is the leading cause of morbidity and mortality. Its screening, diagnosis, and management depend heavily on accurate blood pressure (BP) measurement. It is recommended that the diagnosis of hypertension should be confirmed or corroborated by out-of-office BP values, measured using ambulatory BP monitoring (ABPM) and home BP monitoring (HBPM). When office BP is used, automated office BP (AOBP) measurement method, which automatically provides an average of 3–5 BP readings, should be preferred. This study aimed to describe the BP measurement methods commonly used by doctors in primary care in Hong Kong, to screen, diagnose, and manage hypertensive patients. Methods In this cross-sectional survey, all doctors registered in the Hong Kong “Primary Care Directory” were mailed a questionnaire, asking their preferred BP-measuring methods to screen, diagnose, and manage hypertensive patients. Furthermore, we also elicited information on the usual number of office BP or HBPM readings obtained, to diagnose or manage hypertension. Results Out of the 1738 doctors in the directory, 445 responded. Manual measurement using a mercury or aneroid device was found to be the commonest method to screen (63.1%), diagnose (56.4%), and manage (72.4%) hypertension. There was a significant underutilisation of ABPM, with only 1.6% doctors using this method to diagnose hypertension. HBPM was used by 22.2% and 56.8% of the respondents to diagnose and manage hypertension, respectively. A quarter (26.7%) of the respondents reported using only one in-office BP reading, while 40% participants reported using ≥12 HBPM readings. Doctors with specialist qualification in family medicine were more likely to use AOBP in clinics and to obtain the recommended number of office BP readings for diagnosis and management of hypertension. Conclusion Doctors in Hong Kong primary care prefer to use manual office BP values, measured using mercury or aneroid devices, to screen, diagnose, and manage hypertension, highlighting a marked underutilisation of AOBP and out-of-office BP measuring techniques, especially that of ABPM. Further studies are indicated to understand the underlying reasons and to minimise the gap between real-life clinical practice and those recommended, based on scientific advances.

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“…An online survey, which was conducted by The College of Family Physicians of Canada and involved 774 family physicians (response rate, 16.2%), found that AOBP was a common method to screen (42.9%), diagnose (31.1%), and manage (59.2%) HT, while ABPM was reported as the primary diagnostic tool for HT by 14.4% of the respondents [18]. A recent study in the United Kingdom (UK) surveying 489 patients, who self-reported to have BP measured during their last clinic visit, found that only one BP reading was obtained in 286 (59.6%) patients [25]. Considering the findings of the UK study, around 70% of doctors in our study obtained more than 1 clinic reading when manual BP measurement was used, which was higher than the UK study [25].…”

Section: Discussionmentioning

confidence: 99%

“…A recent study in the United Kingdom (UK) surveying 489 patients, who self-reported to have BP measured during their last clinic visit, found that only one BP reading was obtained in 286 (59.6%) patients [25]. Considering the findings of the UK study, around 70% of doctors in our study obtained more than 1 clinic reading when manual BP measurement was used, which was higher than the UK study [25]. However, the authors of the UK study commented that their local guideline suggested duplicate office BP measurements only in patients with high BP readings, and this may explain the low duplicate office BP measurement rate [25].…”

Section: Discussionmentioning

confidence: 99%

Preference of blood pressure measurement methods by primary care doctors in Hong Kong: a cross-sectional survey

et al. 2020

View full text Add to dashboard Cite

Background Hypertension is the most common chronic disease and is the leading cause of morbidity and mortality. Its screening, diagnosis, and management depend heavily on accurate blood pressure (BP) measurement. It is recommended that the diagnosis of hypertension should be confirmed or corroborated by out-of-office BP values, measured using ambulatory BP monitoring (ABPM) and home BP monitoring (HBPM). When office BP is used, automated office BP (AOBP) measurement method, which automatically provides an average of 3–5 BP readings, should be preferred. This study aimed to describe the BP measurement methods commonly used by doctors in primary care in Hong Kong, to screen, diagnose, and manage hypertensive patients. Methods In this cross-sectional survey, all doctors registered in the Hong Kong “Primary Care Directory” were mailed a questionnaire, asking their preferred BP-measuring methods to screen, diagnose, and manage hypertensive patients. Furthermore, we also elicited information on the usual number of office BP or HBPM readings obtained, to diagnose or manage hypertension. Results Of the 1738 doctors included from the directory, 445 responded. Manual measurement using a mercury or aneroid device was found to be the commonest method to screen (63.1%), diagnose (56.4%), and manage (72.4%) hypertension. There was a significant underutilisation of ABPM, with only 1.6% doctors using this method to diagnose hypertension. HBPM was used by 22.2% and 56.8% of the respondents to diagnose and manage hypertension, respectively. A quarter (26.7%) of the respondents reported using only one in-office BP reading, while around 40% participants reported using ≥12 HBPM readings. Doctors with specialist qualification in family medicine were more likely to use AOBP in clinics and to obtain the recommended number of office BP readings for diagnosis and management of hypertension. Conclusion Primary Care doctors in Hong Kong prefer to use manual office BP values, measured using mercury or aneroid devices, to screen, diagnose, and manage hypertension, highlighting a marked underutilisation of AOBP and out-of-office BP measuring techniques, especially that of ABPM. Further studies are indicated to understand the underlying reasons and to minimise the gap between real-life clinical practice and those recommended, based on scientific advances. Trial registration Clinicaltrial.gov; ref. no.: NCT03926897.

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Current practice of usual clinic blood pressure measurement in people with and without diabetes: a survey and prospective ‘mystery shopper’ study in UK primary care

Cited by 13 publications

References 32 publications

<p>Evaluating the Effectiveness of an Additional Risk Minimization Measure to Reduce the Risk of Prescribing Mirabegron to Patients with Severe Uncontrolled Hypertension in Four European Countries</p>

<p>Evaluating the Effectiveness of an Additional Risk Minimization Measure to Reduce the Risk of Prescribing Mirabegron to Patients with Severe Uncontrolled Hypertension in Four European Countries</p>

Preference of blood pressure measurement methods by primary care doctors in Hong Kong: A cross-sectional survey

Preference of blood pressure measurement methods by primary care doctors in Hong Kong: a cross-sectional survey

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