SAN DIEGO -- Across internal medicine specialties, endocrinology and others stood out for their very low documentation of hypertension in patient notes, a study found.
A compilation of a random sample of 10,000 patients with clinic visits, and a keyword search of the 5,600 clinic visits associated with elevated blood pressures (BPs), revealed rheumatology, immunology, and endocrinology to explicitly mention elevated BP or hypertension in the notes for fewer than 10% of cases, according to Linnea Polgreen, PhD, of University of Iowa College of Pharmacy in Iowa City.
In contrast, the usual specialties associated with BP care -- nephrology, internal medicine, and cardiology -- all topped 50% documentation of BP exceeding 140/90 mmHg. In fact, nephrology led the pack at nearly 80% documentation, Polgreen's group reported in a poster at the Hypertension meeting hosted by the American Heart Association (AHA).
Endocrinology's subpar performance may be a surprise given that BP control is integral to the care of diabetes patients. Hypertension is a in people with type 2 diabetes, and both are significant cardiovascular risk factors.
Meanwhile, a tsunami of cardiovascular disease is expected by the year 2060, when models project 54.6 million Americans with diabetes and 162.5 million with hypertension.
The question is whether all medical disciplines need to start addressing hypertension more.
"These findings introduce an important discussion point around the purpose of BP measurement in clinical practice. Arguably all BP should be measured well and documented, but some argue that BP measurement for the purpose of vital signs can be less rigorous," according to Stephen Juraschek, MD, PhD, of Beth Israel Deaconess Medical Center and Harvard Medical School in Boston.
"I think this study speaks more broadly to the fact that BP is likely measured in all these other settings without being a focus of care. This lack of focus is often reflected by more lax and less standardized approaches to BP measurements. The problem is magnified among non-medical specialties," Juraschek, who was not involved in the study, told 鶹ý.
"Certainly internal medicine should take the lead in BP measurement, but within medicine, I'm happy to see that nephrology, internal medicine, and cardiology are taking the lead," he added.
Polgreen's group reported that the specialties in the middle of the pack by hypertension documentation were infectious disease, pulmonology, gastroenterology, and hematology/oncology, all in the 15%-25% range.
"Our results suggest specialties focused on the management of hypertension are substantially more likely to address elevated BP in their documentation. However, there appears to be room for improvements in documentation across all specialties," they concluded.
The researchers noted that BP is routinely measured and recorded at almost all healthcare visits. "Given the extent of undiagnosed and undertreated hypertension, missed opportunities to address elevated BP readings must be common," they stated.
As such, future work will need to assess the effect of these missed opportunities on the diagnosis and management of hypertension, they added.
The present study was based on clinic visits to Polgreen's institution starting in January 2017. BP was considered elevated when it crossed the threshold of 140/90 mmHg.
Notably, American cardiology societies had lowered the national BP target to 130/80 mmHg for the general population in late 2017.
Disclosures
Polgreen disclosed no relationships with industry.
Juraschek disclosed support from the AHA and NIH.
Primary Source
Hypertension
Zetumer SD, et al "The proportion of physician notes addressing elevated blood pressures varies dramatically across internal medicine specialties" Hypertension 2022.