Delayed Diagnosis of Hypertension in Diabetic Patients Monitored in Primary Care

Burgos‐Lunar, Carmen de; Cura-González, Isabel del; Salinero-Fort, Miguel A; Gómez-Campelo, Paloma; Isla, Leopoldo Pérez de; Jiménez-García, Rodrigo

doi:10.1016/j.rec.2013.01.019

Cited by 7 publications

(11 citation statements)

References 29 publications

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“…Although provider On Medicaid at any point during the baseline or study period § JNC 7 Stage of Hypertension = severity of blood pressure elevation at study entry ‖ ACG = Adjusted Clinical Group Case-Mix Assessment System factors were not significant among young adults, younger providers were less likely to prescribe antihypertensive medication in the overall population. Previous studies from Spain 38 and Italy 39 demonstrated that practitioners ≥ 50 years old had longer mean hypertension diagnosis times and increased rates of uncontrolled hypertension among older patients (mean 64-66 years old). Our study differences may represent variations in patient populations.…”

Section: Discussionmentioning

confidence: 96%

“…Unadjusted Cox proportional hazards limited to young adults demonstrated that 18-29 year-olds had a slower rate of antihypertensive medication initiation or normalization (HR 0.83; 0.66-1.04) compared to [30][31][32][33][34][35][36][37][38][39] year-olds (Table 3). Even after adjustment, age remained a significant predictor of slower medication initiation.…”

Section: Predictors Of Time To Antihypertensive Medication/hypertensimentioning

confidence: 99%

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Antihypertensive Medication Initiation Among Young Adults with Regular Primary Care Use

et al. 2014

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Section: Discussionmentioning

confidence: 96%

Section: Predictors Of Time To Antihypertensive Medication/hypertensimentioning

confidence: 99%

Antihypertensive Medication Initiation Among Young Adults with Regular Primary Care Use

et al. 2014

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“…A study in Spain evaluated delays in hypertension diagnosis among patients with diabetes mellitus. 3 Although generalizability to a U.S. population is limited due to healthcare system differences, similarly, patient-level factors (comorbidities) were the primary associations with hypertension diagnosis and treatment rates. In addition, several studies described delays in hypertension diagnosis and treatment in a U.S. population not limited to patients with diabetes.…”

Section: Discussionmentioning

confidence: 99%

“…Overall, 49 % of patients were male, 14 % had a history of Medicaid, 69 % were obese, and 83 % had stage 1 hypertension. 3 Many chronic conditions, including dyslipidemia, atrial fibrillation, and ischemic heart disease/congestive heart failure, were more common in ≥ 60-year olds than in younger age groups.…”

Section: Descriptive Datamentioning

confidence: 99%

“…Despite the importance of controlling blood pressure in patients with diabetes mellitus, there is evidence that blood pressure control is suboptimal among U.S. patients with diabetes. 2,3 A better understanding of factors associated with delays in diagnosis and treatment of hypertension among patients with diabetes could inform the development of interventions to improve the clinical care of diabetes. We therefore aimed to identify associations with an initial hypertension diagnosis and antihypertensive medication initiation among individuals with diabetes mellitus.…”

Section: Introductionmentioning

confidence: 99%

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Diagnosis and Treatment of Incident Hypertension Among Patients with Diabetes: a U.S. Multi-Disciplinary Group Practice Observational Study

et al. 2015

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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 and incident 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;) and fewer visits (HR 0.93;) 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.

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Undiagnosed hypertension in Peru: analysis of associated factors and socioeconomic inequalities, 2019

Guerrero-Díaz

Hernández-Vasquéz

Montoya-Rivera

et al. 2021

Heliyon

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To determine the factors associated and measure the socioeconomic inequalities in people with undiagnosed hypertension in Peru. Materials and methods: An observational, cross-sectional, analytical study was performed using data from the 2019 Demographic and Family Health Survey (ENDES, acronym in Spanish) database. The dependent variable was the presence of undiagnosed hypertension (mean systolic blood pressure !140 mmHg and/or mean diastolic blood pressure !90 mmHg in the two blood pressure measurements and with no prior diagnosis of hypertension by a health care professional). Adjusted prevalence ratios were estimated to determine the factors associated with undiagnosed hypertension. The socioeconomic inequality in undiagnosed hypertension was estimated using concentration curves and the Erreygers concentration index. Results: 67.2% of 3697 persons with hypertension had not been diagnosed. Non-diagnosis of hypertension was more prevalent in men who were residents of the Coast and in inhabitants residing at more than 3000 m above sea level. Being 50 years of age or older, having health insurance, being obese and having diabetes mellitus were associated with a lower prevalence of undiagnosed hypertension. Inequality of the non-diagnosis of hypertension was found to be concentrated in the poorest population. Conclusions: At least one out of every two adult Peruvians with hypertension have not been diagnosed with this condition. Socioeconomic inequality was found, as well as socio-demographic and health-related factors associated with undiagnosed hypertension. Our findings identify some population subgroups in which interventions for screening and treatment of hypertension should be prioritized in order to reduce both inequalities and complications of hypertension among the most vulnerable.

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Delayed Diagnosis of Hypertension in Diabetic Patients Monitored in Primary Care

Cited by 7 publications

References 29 publications

Antihypertensive Medication Initiation Among Young Adults with Regular Primary Care Use

Antihypertensive Medication Initiation Among Young Adults with Regular Primary Care Use

Diagnosis and Treatment of Incident Hypertension Among Patients with Diabetes: a U.S. Multi-Disciplinary Group Practice Observational Study

Undiagnosed hypertension in Peru: analysis of associated factors and socioeconomic inequalities, 2019

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