Expanding Blood Pressure Screenings Beyond Primary Care Can Improve Hypertension Detection

PASADENA, Calif.   – Expanding blood pressure screenings to non-primary care settings can help identify more patients with high blood pressure, commonly called  hypertension, and could contribute to better hypertension control and management, according to a Kaiser Permanente study published today in The Journal of Clinical Hypertension.

Researchers examined the electronic health records of 1,076,000 Kaiser Permanente Southern California patients seen over a two-year period in primary care settings and non-primary care settings, including optometry, orthopedics and urology. The study reported the prevalence of hypertension and compared the characteristics of those patients identified with hypertension in a non-primary care setting to those identified in primary care settings.

Of the patients studied, 112,000 were found to have high blood pressure by the end of the two-year study period. Of these, 83 percent were diagnosed in a primary care setting and 17 percent in a non-primary care setting. The main non-primary care specialties to first identify a high blood pressure reading were ophthalmology/optometry with 25 percent, neurology with 19 percent, and dermatology with 13 percent. All staff members conducting blood pressure screenings in these clinical settings were certified in blood pressure measurement to ensure consistency in screenings.

According to the researchers, the number of false positives were comparable between both settings, suggesting that blood pressure readings in non-primary care settings were as accurate as those taken in primary care settings. Patients who were screened in non-primary care settings and found to have high blood-pressure readings were sent back for follow-up visits with their primary care provider.

Patients who do not see their primary care providers on a regular basis may have hypertension that goes unrecognized, said study lead author and hypertension lead Joel Handler, MD, Southern California Kaiser Permanente hypertension lead. For this reason, expanding hypertension screening to non-primary care settings may be an opportunity to improve early hypertension recognition and control.

The study indicated that patients identified with hypertension during non-primary care visits were more likely to be older, male and non-Hispanic white. In addition, these patients were also more likely to smoke and to have chronic kidney disease. Researchers also found that patients with an initial high blood pressure identified during non-primary care were less likely to be obese compared to those with an initial high blood pressure identified during a primary care visit.

The differences in the patient characteristics observed in our study suggest that expanding hypertension screening to non-primary care settings may also help identify patients who would have been missed otherwise, said study co-author Corinna Koebnick, PhD, Kaiser Permanente Southern California Department of Research & Evaluation. However, this approach requires an effective system, such as the one in place at Kaiser Permanente, to assure appropriate follow-up if a patient with high blood pressure is detected.

High blood pressure is a common and dangerous condition that affects approximately 1 in 3 adults, or 67 million people, in the U.S., according to the Centers for Disease Control and Prevention. The CDC estimates that only about half of people with hypertension have their condition under control. High blood pressure, which often has no warning signs or symptoms, increases the risk for heart disease and stroke, two of the leading causes of death for Americans.

This research is part of Kaiser Permanente’s continuing efforts to address the impacts of hypertension and improve the cardiovascular health of its members and the community. In August, a Kaiser Permanente study found that both overtreatment and undertreatment of patients with high blood pressure was linked to kidney failure and death. And last year, researchers announced that Kaiser Permanente Northern California nearly doubled the rate of blood pressure control among adult members with diagnosed hypertension between 2001 and 2009 through one of the largest, community-based hypertension programs in the nation.

Other authors of the paper include: Yasmina Mohan, MPH, Kristi Reynolds, PhD, MPH, Xia Li, MS, Miki Nguyen, MPH, and Deborah R. Young, PhD, of the Kaiser Permanente Southern California Department of Research & Evaluation; and Michael Kanter, MD, of the Southern California Permanente Medical Group.

About the Kaiser Permanente Southern California Department of Research & Evaluation

The Department of Research & Evaluation conducts high-quality, innovative research into disease etiology, prevention, treatment and care delivery. Investigators conduct epidemiology, health sciences and behavioral research as well as clinical trials. Areas of interest include diabetes and obesity, cancer, HIV/AIDS, cardiovascular disease, aging and cognition, pregnancy outcomes, women’s and children’s health, quality and safety, and pharmacoepidemiology. Located in Pasadena, California, the department focuses on translating research to practice quickly to benefit the health and lives of Kaiser Permanente Southern California members and the general population. Visit kp.org/research.

About Kaiser Permanente
Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, Kaiser Permanente has a mission to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve approximately 9.6 million members in eight states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: kp.org/share.