Delayed Hypertension Diagnosis Tied to Higher Cardiovascular Risk

Delays in formally diagnosing hypertension are common and tied to significantly lower rates of treatment initiation and increased long-term cardiovascular risk, according to research published in JAMA Network Open.

“Hypertension affects nearly 50% of individuals in the US, and its persistent elevation can lead to severe health complications,” explained the study authors. “Evidence-based guidelines emphasize the importance of early detection and treatment to mitigate the cumulative risk of adverse outcomes over time. Timely diagnosis is critical for initiating effective treatment, but the association of diagnostic delay with cardiovascular outcomes is understudied.”

 The investigators conducted a retrospective cohort study to evaluate the timing of clinical hypertension diagnosis and its associations with antihypertensive medication prescribing and long-term cardiovascular outcomes.

They used electronic health record (EHR) data from a large non-profit integrated healthcare system with 12 hospitals and 566 outpatient sites in Virginia and North Carolina. The study population was adults 18-85 years of age with greater than or equal to two outpatient blood pressure (BP) readings of greater than or equal to 140/90 mm Hg, recorded at least 30 days apart in the EHR (meeting a “computed hypertension diagnosis”) from 2010 to 2021.

The investigators assessed the timing of the formal clinical hypertension diagnosis recorded by a clinician relative to the second elevated BP measurement in the EHR. They categorized these diagnoses into one of four groups: a preexisting diagnosis; diagnosed between the first and second BP elevations (reference group); delayed diagnosis (diagnosed after the second BP elevation, which was subdivided into 1-90 days, 91-365 days, or >365 days after the second BP elevation); and no recorded diagnosis.

The primary outcome was antihypertensive medication prescription within 30 days of diagnosis. The secondary outcome was the 5-year composite risk for myocardial infarction, ischemic stroke, or heart failure hospitalization.

 There were 311,743 patients with a computed hypertension diagnosis (mean age, 57.9 years; 53.3% women; 69.6% non-Hispanic White, 24.9% non-Hispanic Black, 2.4% Hispanic or Latino, and 1.7% non-Hispanic Asian). Of those, 14.6% received a delayed clinical hypertension diagnosis (after the second elevated BP measurement).

After adjustment for demographic data, BP, and comorbidities, multivariable analysis revealed that delayed diagnosis was associated with lower antihypertensive medication prescription rates (30.6% vs 75.2% for the reference group; P<.001) and increased cardiovascular risk over 5 years (delay of 1-90 days: hazard ratio [HR], 1.04; 95% confidence interval [CI], 0.95-1.13; delay of 91-365 days: HR, 1.11; 95% CI, 1.04-1.19; and delay of 365 days: HR, 1.29; 95% CI, 1.23-1.36).

The investigators also evaluated the data by demographic groups and found that greater delay in clinical diagnosis of hypertension was associated with younger age (median delay, 17.5 months for 45-64 years vs 13.4 months for ≥75 years; P<.001), female sex (median delay, 16.6 months for females vs 16.1 months for males; P<.001), and non-Hispanic Asian or non-Hispanic Black race (median delay, 18.5 months for non-Hispanic Asian and 17.2 months for non-Hispanic Black vs 16.3 months for non-Hispanic White; P<.001).

“Our findings extend prior work by demonstrating that not only are delays in hypertension diagnosis frequent, but they also follow a graded association with both lower antihypertensive treatment initiation and increased long-term cardiovascular risk. Patients diagnosed more than 1 year after the second elevated BP measurement had a nearly 30% higher risk of cardiovascular events compared with those diagnosed earlier,” added the authors. “Our findings highlight the clinical significance of delayed hypertension recognition and the potential association of earlier intervention with mitigation of cardiovascular risk.”

The study also highlights how EHR systems could be leveraged to help facilitate earlier recognition and interventions for the treatment of hypertension.

Disclosure(s):

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.