Blood pressure control in Australian general practice: analysis using general practice records of 1.2 million patients from the MedicineInsight database

Abstract

Introduction: Hypertension is mostly managed in primary care. This study investigated the prevalence of diagnosed hypertension in Australian general practice and whether hypertension control is influenced by sociodemographic characteristics, duration since diagnosis or prescription of antihypertensive medications.Methods: Cross-sectional study using a large national database of electronic medical records of patients attending general practice in 2017 (MedicineInsight).Results: Of 1.2 million 'regular' patients (one or more consultations per year in every year from 2015 to 2017), 39.8% had a diagnosis of hypertension (95% confidence interval 38.7-40.9). Of these, 85.3% had their blood pressure (BP) recorded in 2017, and 54.9% (95% confidence interval 54.2-55.5) had controlled hypertension (<140/90 mmHg). BP control was lower in females (54.1%) compared with males (55.7%) and in the oldest age group (52.0%), with no differences by socioeconomic status. Hypertension control was lower among 'regular' patients recently diagnosed (6-12 months ¼ 48.6% controlled) relative to those more than 12 months since diagnosis (1-2 years ¼ 53.6%; 3-5 years 55.5%; >5 years ¼ 55.0%). Among recently diagnosed 'regular' patients, 59.2% had no record of being prescribed antihypertensive therapy in the last 6 months of the study, of which 44.3% had controlled hypertension. For those diagnosed more than 5 years ago, 37.4% had no record of being prescribed antihypertensive patients, and 56% had normal BP levels. Conclusion:Although the prevalence of hypertension varied by socidemographics, there were no differences in BP assessment or control by socioeconomic status. Hypertension control remains a challenge in primary care, and electronic medical records provide an opportunity to assess hypertension management.

Uncontrolled blood pressure in Australia: a call to action

“…4 In a sample of patients with hypertension in general practices, the proportion of controlled BP was reported as 54.9% in 2017. 10 A 2020 Australian report acknowledged BP as a biological factor and determinant of health, and listed hypertension as a potentially modifiable condition which leads to hospitalisation, while reiterating coronary heart disease as the leading cause of death. 11 Unfortunately, there seems to be no urgency or priority to address BP control in Australia.…”

The Cost of Uncontrolled Blood Pressure in Australian General Practice: A Modelling Study Using Electronic Health Records (MedicineInsight)

“…We then identified patients with a diagnosis of hypertension. The methods used to identify patients diagnosed with hypertension are described in detail elsewhere [ 8 , 21 ]. Briefly, patients were considered to have hypertension if (1) the condition was recorded as a diagnosis, reason for encounter or reason for prescription or (2) if the patient received a prescription for antihypertensive therapy preceded by an elevated BP (i.e.…”

“…Hypertension is largely managed in primary care and is the most common condition seen by a general practitioner (GP) in Australia [ 7 ]. Despite hypertension being amenable to lifestyle modifications and pharmacological treatment, only around half of the patients attending general practice have controlled hypertension (BP < 140/90 mmHg) [ 8 ]. Poor BP control puts patients at an increased risk of CVD and all-cause and CVD mortality.…”

Predicted cardiovascular disease risk and prescribing of antihypertensive therapy among patients with hypertension in Australia using MedicineInsight

“…at least three visits between 2016 and 2018) [ 23 ]. The methods used to identify patients diagnosed with hypertension have been described elsewhere [ 24 ]. Briefly, GPs can record clinical data (diagnosis, reason for encounter, reason for prescription) with either pre-coded terms or free-text.…”