Missed Opportunities in Cardiovascular Disease Prevention?

Abstract

Younger women use both internal medicine and OBGYN clinics as primary sources of health care. However, the role of OBGYNs in cardiovascular disease (CVD) prevention is largely unexplored. The objective of this study is to examine rates of hypertension recognition in women under 50 who present with elevated blood pressures in family practice and internal medicine (Medicine) and OBGYN clinics, and to compare these rates across clinic type. The study’s population consisted of 34,627 non-pregnant women ages 18–49 with new-onset hypertension (defined as two consecutive visits with elevated blood pressures of SBP ≥140mmHg or DBP ≥90 mmHg with no prior hypertension history) from 2002–2006. Multivariate logistic regressions predicting the clinical recognition of hypertension (a recorded diagnosis of hypertension and/or an antihypertensive prescription by any provider within one year of the second elevated blood pressure) assessed the association between hypertension recognition and the clinic where the second elevated blood pressure was recorded. Analysis showed that hypertension was recognized in less than 33% of women with new-onset hypertension. Women whose second consecutive elevated blood pressure was recorded in OBGYN were less likely to be recognized as having hypertension within 12 months by any provider compared to women whose second consecutive elevated blood pressure was recorded in Medicine (OR=0.51;95% CI=(0.48, 0.54)). This study suggests that further attention be paid to identifying and treating CVD risk factors in women under 50 presenting in both Medicine and OBGYN, and that improved coordination across care settings has the potential to improve CVD prevention in young women.

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