Antihypertensive Medication Initiation Among Young Adults with Regular Primary Care Use

Johnson, Heather M.; Thorpe, Carolyn T.; Bartels, Christie M.; Schumacher, Jessica R.; Palta, Mari; Pandhi, Nancy; Sheehy, Ann M.; Smith, Maureen A.

doi:10.1007/s11606-014-2790-4

Cited by 42 publications

(44 citation statements)

References 38 publications

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“…In addition, several studies described delays in hypertension diagnosis and treatment in a U.S. population not limited to patients with diabetes. 10,[33][34][35] Similar to those studies, we demonstrated that fewer primary care visits in the baseline period were associated with slower diagnosis and treatment rates, emphasizing the importance of timely hypertension follow-up.…”

Section: Discussionsupporting

confidence: 77%

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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Section: Discussionsupporting

confidence: 77%

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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“…A semi-structured interview guide was developed based on previous literature of barriers to hypertension control across populations [10, 14, 15, 17, 21–24] and barriers to managing other cardiovascular risk factors among adolescents/young adults (e.g., diabetes [25, 26]). Provider participants were asked a total of 16 questions on the following topics: (1) their personal blood pressure threshold to diagnose hypertension and start lifestyle modification and/or antihypertensive medication, (2) reluctance or hesitancy among themselves or their colleagues to diagnose hypertension and/or start medication, and (3) hypertension guideline applicability for young adults compared to middle-aged and older adults.…”

Section: Methodsmentioning

confidence: 99%

“…Although lifestyle modifications is important therapy for all young adults with hypertension [11, 12], we demonstrated low rates of lifestyle counseling for young adults with incident (new) hypertension [13]. Additionally, among young adults with severe hypertension (stage 2: ≥160/100 mmHg), we documented significant delays (years) in providers combining lifestyle modification counseling [13] with an initial antihypertensive medication [14]. Multiple studies have also assessed barriers to hypertension control [15–18].…”

Section: Introductionmentioning

confidence: 99%

“They’re younger… it’s harder.” Primary providers’ perspectives on hypertension management in young adults: a multicenter qualitative study

et al. 2017

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BackgroundYoung adults (18–39 year-olds) have the lowest hypertension control rates among adults with hypertension in the United States. Unique barriers to hypertension management in young adults with primary care access compared to older adults have not been evaluated. Understanding these differences will inform the development of hypertension interventions tailored to young adults. The goals of this multicenter study were to explore primary care providers’ perspectives on barriers to diagnosing, treating, and controlling hypertension among young adults with regular primary care.MethodsPrimary care providers (physicians and advanced practice providers) actively managing young adults with uncontrolled hypertension were recruited by the Wisconsin Research & Education Network (WREN), a statewide practice-based research network. Semi-structured qualitative interviews were conducted in three diverse Midwestern clinical practices (academic, rural, and urban clinics) using a semi-structured interview guide, and content analysis was performed.ResultsPrimary care providers identified unique barriers across standard hypertension healthcare delivery practices for young adults. Altered self-identity, greater blood pressure variability, and unintended consequences of medication initiation were critical hypertension control barriers among young adults. Gender differences among young adults were also noted as barriers to hypertension follow-up and antihypertensive medication initiation.ConclusionsTailored interventions addressing the unique barriers of young adults are needed to improve population hypertension control. Augmenting traditional clinic structure to support the “health identity” of young adults and self-management skills are promising next steps to improve hypertension healthcare delivery.Electronic supplementary materialThe online version of this article (doi:10.1186/s13104-016-2332-8) contains supplementary material, which is available to authorized users.

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“…40,41 A recent study showed that younger adults were less likely than older adults to receive anti-hypertensive treatment, suggesting that greater awareness of the importance of earlier life blood pressure is needed. 42 Prior studies suggest that public health strategies such as dietary modifications (e.g. Dietary Approaches to Stop Hypertension [DASH] diet, lower dietary salt intake, increased intake of potassium and fruits and vegetables, smoking) and weight loss in overweight people may be effective; and statins may be worthwhile to prevent the development of hypertension or aortic stiffness, and which in turn may lead to prevention of kidney disease, but this requires explicit evaluation.…”

Section: Discussionmentioning

confidence: 99%

Midlife Blood Pressure and Late-Life GFR and Albuminuria: An Elderly General Population Cohort

Inker

Okparavero

Tighiouart

et al. 2015

American Journal of Kidney Diseases

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Background Chronic kidney disease (CKD) is common in the elderly, but the cause is often not identifiable. Some posit that age-related reductions in glomerular filtration rate (GFR) and increases in albuminuria are normal, whereas others suggest that they are a consequence of vascular disease. Study Design Cross-sectional analysis of a substudy of a prospective cohort. Setting & Participants AGES (Age, Gene/Environment Susceptibility)-Reykjavik Study. Predictor Exposure to higher blood pressure in midlife. Outcomes & Measurements Measured GFR using plasma clearance of iohexol and urine albumin-creatinine ratio (ACR). Results GFR was measured in 805 participants with mean age in midlife and late life of 51.0 ±5.8 and 80.8 ±4.0 (SD) years, respectively. Mean measured GFR was 62.4 ±16.5 ml/min/1.73 m2 and median albuminuria was 8.0 (IQR, 5.4–16.5) mg/g. Higher midlife systolic and diastolic blood pressures were associated with lower later life GFR. Associations persisted after adjustment. Higher midlife systolic and diastolic blood pressures were also associated with higher ACR, and associations remained significant even after adjustment. Limitations This is a study of survivors, and people who agreed to participate in this study were healthier than those who refused. Blood pressure may encompass effects of the other risk factors. Results may not be generalizable to populations of other races. We were not able to adjust for measured GFR or albuminuria at the midlife visit. Conclusions Factors other than advanced age may account for the high prevalence of CKD in the elderly. Midlife factors are potential contributing factors to late-life kidney disease. Further studies are needed to identify and treat midlife modifiable factors to prevent the development of CKD.

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Antihypertensive Medication Initiation Among Young Adults with Regular Primary Care Use

Cited by 42 publications

References 38 publications

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

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

“They’re younger… it’s harder.” Primary providers’ perspectives on hypertension management in young adults: a multicenter qualitative study

Midlife Blood Pressure and Late-Life GFR and Albuminuria: An Elderly General Population Cohort

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