Methods of defining hypertension in electronic medical records: validation against national survey data

Peng, Mingkai; Chen, Guanmin; Kaplan, Gilaad G.; Lix, Lisa M.; Drummond, Neil; Lucyk, Kelsey; Garies, Stephanie; Lowerison, Mark; Weibe, Samuel; Quan, Hude

doi:10.1093/pubmed/fdv155

Cited by 39 publications

(42 citation statements)

References 20 publications

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“…Electronic medical records (EMR) contain rich clinical information, in which more than 50% of patients have at least 2 blood pressure measurements [ 12 ]. EMR also provides a population-based sample with the ability to follow patients for long periods of time.…”

Section: Introductionmentioning

confidence: 99%

Blood pressure at age 60–65 versus age 70–75 and vascular dementia: a population based observational study

et al. 2017

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BackgroundVascular dementia (VaD) is the second most common form of dementia. However, there were mixed evidences about the association between blood pressure (BP) and risk of VaD in midlife and late life and limited evidence on the association between pulse pressure and VaD.MethodsThis is a population-based observational study. 265,897 individuals with at least one BP measurement between the ages of 60 to 65 years and 211,116 individuals with at least one BP measurement between the ages of 70 to 75 years were extracted from The Health Improvement Network in United Kingdom. Blood pressures were categorized into four groups: normal, prehypertension, stage 1 hypertension, and stage 2 hypertension. Cases of VaD were identified from the recorded clinical diagnoses. Multivariable survival analysis was used to adjust other confounders and competing risk of death. All the analysis were stratified based on antihypertensive drug use status. Multiple imputation was used to fill in missing values.ResultsAfter accounting for the competing risk of death and adjustment for potential confounders, there was an association between higher BP levels in the age 60–65 cohort with the risk of developing VaD (hazard ratio [HR] 1.53 (95% confidence interval: 1.04, 2.25) for prehypertension, 1.90 (1.30, 2.78) for stage 1 hypertension, and 2.19 (1.48, 3.26) for stage 2 hypertension) in the untreated group. There was no statistically significant association between BP levels and VaD in the treated group in the age 60–65 cohort and age 70–75 cohort. Analysis on Pulse Pressure (PP) stratified by blood pressure level showed that PP was not independently associated with VaD.ConclusionHigh BP between the ages of 60 to 65 years is a significant risk for VaD in late midlife. Greater efforts should be placed on early diagnosis of hypertension and tight control of BP for hypertensive patients for the prevention of VaD.Electronic supplementary materialThe online version of this article (10.1186/s12877-017-0649-3) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Blood pressure at age 60–65 versus age 70–75 and vascular dementia: a population based observational study

et al. 2017

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“…[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. 9,10,22,25 The Netherlands, 26 the UK 27 and Spain, 28 but not Finland, use monitoring of risk factors such as BP as indicators to monitor the quality of care for chronic diseases.…”

Section: Discussionmentioning

confidence: 99%

<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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“…A literature search of the terms “THIN” and “validation” revealed that the THIN database has been validated for the Read codes for some but not all of the covariates used in this study. 16 , 25 – 29 It is important to note that the GOLD guidelines were updated while the manuscript was in progress. Although GOLD guidance, such as GOLD 2011/2013, may have been contemporary to treatment practices during the study period, we additionally assessed patients according to GOLD 2017 grouping, in order to demonstrate how physicians may need to adapt their treatment practices in light of new evidence.…”

Section: Discussionmentioning

confidence: 99%

Factors influencing treatment escalation from long-acting muscarinic antagonist monotherapy to triple therapy in patients with COPD: a retrospective THIN-database analysis

Hurst¹,

Dilleen²,

Morris³

et al. 2018

COPD

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PurposeInappropriate use of an inhaled corticosteroid (ICS) for COPD has clinical and economic disadvantages. This retrospective analysis of The UK Health Improvement Network (THIN) database identified factors influencing treatment escalation (step-up) from a long-acting muscarinic antagonist (LAMA) to triple therapy (LAMA + long-acting β-agonist-ICS). Secondary objectives included time to step up from first LAMA prescription, Global Initiative for Chronic Obstructive Lung Disease (GOLD) grouping (2011/2013, 2017), and Medical Research Council (MRC) grade prior to treatment escalation.Materials and methodsData were included from 14,866 people ≥35 years old with a COPD diagnosis (June 1, 2010–May 10, 2015) and initiated on LAMA monotherapy. The most commonly used LAMA at baseline was tiotropium (92%).ResultsMultivariate analysis (10,492 patients) revealed that COPD exacerbations, lower forced expiratory volume in 1 second (FEV1), “asthma”, MRC grade, proactive and reactive COPD primary care, elective secondary-care contact, cough, and number of short-acting bronchodilator prescriptions were positively associated with treatment escalation (P<0.05). Being older, a current/ex-smoker, or having increased sputum symptom codes were negatively associated with treatment escalation (P<0.05). Median MRC score was 2 at baseline and 3 prior to treatment escalation. Using the last MRC reading and exacerbation history in the year prior to escalation, GOLD 2017 groupings were A 27.4%, B 37.3%, C 15.3%, and D 20%. In patients with available FEV1 measures, exacerbations, and MRC code (n=1,064), GOLD 2011/2013 groupings were A 20.4%, B 19.2%, C 24.8%, and D 35.6%.ConclusionWhile the presence of COPD exacerbations seems to be the main driver for treatment escalation, according to the 2017 GOLD strategy many patients appear to be overtreated, as they would not be recommended for treatment escalation. Reviewing patients’ treatment in the light of the new GOLD strategy has the potential to reduce inappropriate use of triple therapy.

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Methods of defining hypertension in electronic medical records: validation against national survey data

Cited by 39 publications

References 20 publications

Blood pressure at age 60–65 versus age 70–75 and vascular dementia: a population based observational study

Blood pressure at age 60–65 versus age 70–75 and vascular dementia: a population based observational study

<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>

Factors influencing treatment escalation from long-acting muscarinic antagonist monotherapy to triple therapy in patients with COPD: a retrospective THIN-database analysis

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