DOCUMENTS

papers

Undiagnosed hypertension among young adults with regular primary care use

Published: January 1, 2014
Category: Papers
Authors: Bartels CM, Johnson HM, Palta M, Pandhi N, Schumacher JR, Sheehy AM, Smith MA, Thorpe CT
Country: United States
Language: null
Type: Population Health
Settings: Hospital, PCP

J Hypertens 32:65-74.

University of Wisconsin School of Medicine and Public Health, Madison, WI; Veterans Affairs Pittsburgh Healthcare System and School of Pharmacy, University of Pittsburgh, Pittsburgh, PA. USA

OBJECTIVE: Young adults meeting hypertension diagnostic criteria have a lower prevalence of a hypertension diagnosis than middle-aged and older adults. The purpose of this study was to compare the rates of a new hypertension diagnosis for different age groups and identify predictors of delays in the initial diagnosis among young adults who regularly use primary care.

METHODS: A 4-year retrospective analysis included 14 970 patients, at least 18 years old, who met clinical criteria for an initial hypertension diagnosis in a large, Midwestern, academic practice from 2008 to 2011. Patients with a previous hypertension diagnosis or prior antihypertensive medication prescription were excluded. The probability of diagnosis at specific time points was estimated by Kaplan-Meier analysis. Cox proportional hazard models (hazard ratio; 95% confidence interval) were fit to identify predictors of delays to an initial diagnosis, with a subsequent subset analysis for young adults (18-39 years old).

RESULTS: After 4 years, 56% of 18-24-year-olds received a diagnosis compared with 62% (25-31-year-olds), 68% (32-39-year-olds), and more than 70% (≥40-year-olds). After adjustment, 18-31-year-olds had a 33% slower rate of receiving a diagnosis (18-24 years hazard ratio 0.66, 0.53-0.83; 25-31 years hazard ratio 0.68, 0.58-0.79) compared with adults at least 60 years. Other predictors of a slower diagnosis rate among young adults were current tobacco use, white ethnicity, and non-English primary language. Young adults with diabetes, higher blood pressures, or a female provider had a faster diagnosis rate.

CONCLUSION: Provider and patient factors are critical determinants of poor hypertension diagnosis rates among young adults with regular primary care use.

PMID: 24126711

PMCID: PMC3868024

United States,Diagnostic Certainty,Co-morbidity,Medication,Adolescent,Adult,Counseling,Gender,Life Style,Patient Education as Topic,Retrospective Studies,Young Adult

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