Trends in Blood Pressure Among Adults With Hypertension

Yoon, Sung Sug; Gu, Qiuping; Nwankwo, Tatiana; Wright, Jacqueline D.; Hong, Yuling; Burt, Vicki L.

doi:10.1161/hypertensionaha.114.04012

Cited by 234 publications

(152 citation statements)

References 25 publications

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“…27 This study was reviewed by the internal review board and found to be exempt from requiring informed consent. We randomly selected 643 adults with regular outpatient care, defined as at least 2 outpatient visits and 2 blood pressure readings between January 1, 2007, and January 1,2009. Vitals are routinely recorded at all visits for all patients (including all internal medicine clinics), regardless of hypertension status.…”

Section: Patient Selection and Review At Vanderbilt University Medicamentioning

confidence: 99%

Evaluating electronic health record data sources and algorithmic approaches to identify hypertensive individuals

Teixeira

Wei

Cronin

et al. 2016

Journal of the American Medical Informatics Association

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Objective: Phenotyping algorithms applied to electronic health record (EHR) data enable investigators to identify large cohorts for clinical and genomic research. Algorithm development is often iterative, depends on fallible investigator intuition, and is time-and labor-intensive. We developed and evaluated 4 types of phenotyping algorithms and categories of EHR information to identify hypertensive individuals and controls and provide a portable module for implementation at other sites. Materials and Methods: We reviewed the EHRs of 631 individuals followed at Vanderbilt for hypertension status. We developed features and phenotyping algorithms of increasing complexity. Input categories included International Classification of Diseases, Ninth Revision (ICD9) codes, medications, vital signs, narrative-text search results, and Unified Medical Language System (UMLS) concepts extracted using natural language processing (NLP). We developed a module and tested portability by replicating 10 of the best-performing algorithms at the Marshfield Clinic. Results: Random forests using billing codes, medications, vitals, and concepts had the best performance with a median area under the receiver operator characteristic curve (AUC) of 0.976. Normalized sums of all 4 categories also performed well (0.959 AUC). The best non-NLP algorithm combined normalized ICD9 codes, medications, and blood pressure readings with a median AUC of 0.948. Blood pressure cutoffs or ICD9 code counts alone had AUCs of 0.854 and 0.908, respectively. Marshfield Clinic results were similar. Conclusion: This work shows that billing codes or blood pressure readings alone yield good hypertension classification performance. However, even simple combinations of input categories improve performance. The most complex algorithms classified hypertension with excellent recall and precision.

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Section: Patient Selection and Review At Vanderbilt University Medicamentioning

confidence: 99%

Evaluating electronic health record data sources and algorithmic approaches to identify hypertensive individuals

Teixeira

Wei

Cronin

et al. 2016

Journal of the American Medical Informatics Association

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“…If there are differences in the risk factor profiles of the 2 countries, it is also not clear if the differences are a result of a contrast in the underlying prevalence of the risk factors or marked differences in treatment and control of the risk factors. The rates of treatment and control of cardiovascular risk factors in the United States have increased markedly in recent decades, whereas studies suggest that China is lagging in risk factor management 8, 9, 10. These prior studies, however, are not suitable for country‐to‐country comparison because of differences in the study samples and the survey methods.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Prevalence, Awareness, Treatment, and Control of Cardiovascular Risk Factors in China and the United States

Pei²,

Zhou

et al. 2018

JAHA

126

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BackgroundThe reasons for China's high stroke prevalence are not well understood. The cardiovascular risk factor profiles of China and the United States have not been directly compared in nationally representative population samples.Methods and ResultsUsing data from the CHARLS (China Health and Retirement Longitudinal Study) and the NHANES (US National Health and Nutrition Examination Survey), we compared cardiovascular risk factors from 2011 to 2012 among people aged 45 to 75 years between the 2 countries (China, 12 654 people; United States, 2607 people): blood pressure, cholesterol, body mass index, waist circumference, fasting plasma glucose, hemoglobin A1c, and high‐sensitivity C‐reactive protein. Compared with the United States, China had a lower prevalence of hypertension but a higher mean blood pressure and a higher proportion of patients with severe hypertension (≥160/100 mm Hg) (10.5% versus 4.5%). China had substantially lower rates of hypertension treatment (46.8% versus 77.9%) and control (20.3% versus 54.7%). Dyslipidemia was less common in China, but lipid levels were not significantly different because dyslipidemia awareness and control rates in China were 3‐ and 7‐fold lower than US rates, respectively. High‐sensitivity C‐reactive protein, body mass index, and waist circumference were significantly lower in China than in the United States. Clustering of hypertension with other cardiovascular risk factors was more common in China.ConclusionsHypertension is more common in the United States, but blood pressure levels are higher in China, which may be responsible for China's high stroke prevalence. The low rates of awareness, treatment, and control of hypertension provide an exceptional opportunity for China to reduce risk in its population.

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“…Hypertension is widely prevalent and largely manageable yet remains uncontrolled in nearly half of US hypertensive adults 1, 2, 3. Although effective pharmaceutical treatments are readily available and reduce the risk for major cardiovascular diseases,4 inadequate adherence among patients to hypertension medication and the inertia of physicians to intensify treatment contribute to substantial morbidity, mortality, hospitalization, and health care costs 5, 6, 7.…”

Section: Introductionmentioning

confidence: 99%

Treatment Intensification for Hypertension in US Ambulatory Medical Care

Lin

Mukamal

2016

JAHA

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BackgroundHypertension is widely prevalent yet remains uncontrolled in nearly half of US hypertensive adults. Treatment intensification for hypertension reduces rates of major cardiovascular events and all‐cause mortality, but clinical inertia remains a notable impediment to further improving hypertension control. This study examines the likelihood and determinants of treatment intensification with new medication in US ambulatory medical care.Methods and ResultsUsing the nationally representative National Ambulatory Medical Care Survey (2005–2012) and National Hospital Ambulatory Medical Care Survey (2005–2011), we identified adult primary care visits with diagnosed hypertension and documented blood pressure exceeding goal targets and assessed the weighted prevalence and odds ratios of treatment intensification by initiation or addition of new medication. Approximately 41.7 million yearly primary care visits (crude N: 14 064, 2005–2012) occurred among US hypertensive adults with documented blood pressure ≥140/90 mm Hg, where treatment intensification may be beneficial. However, only 7.0 million of these visits (95% confidence interval 6.2–7.8 million) received treatment intensification with new medication, a weighted prevalence of 16.8% (15.8% to 17.9%). This proportion was consistently low and decreased over time. This decline was largely driven by decreasing medication initiation levels among patients on no previous hypertension medications from 31.8% (26.0% to 38.4%) in 2007 to 17.4% (14.0% to 21.4%) in 2012, while medication addition levels remained more stable over time.ConclusionsUS hypertensive adults received treatment intensification with new medication in only 1 out of 6 primary care visits, a fraction that is declining over time. A profound increase in intensification remains a vast opportunity to maximally reduce hypertension‐related morbidity and mortality nationwide.

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Trends in Blood Pressure Among Adults With Hypertension

Cited by 234 publications

References 25 publications

Evaluating electronic health record data sources and algorithmic approaches to identify hypertensive individuals

Evaluating electronic health record data sources and algorithmic approaches to identify hypertensive individuals

Comparison of Prevalence, Awareness, Treatment, and Control of Cardiovascular Risk Factors in China and the United States

Treatment Intensification for Hypertension in US Ambulatory Medical Care

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