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The new "normal" blood pressure: what are the implications for family medicine?
1Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. anthony_viera@med.unc.edu
Insights
Most family medicine patients have high blood pressure (hypertension) or prehypertension, not normal blood pressure. This finding presents a new challenge for clinicians managing blood pressure in primary care settings.
Area of Science:
- Cardiology
- Family Medicine
- Public Health
Background:
- The 2003 Joint National Committee guidelines redefined normal blood pressure (BP) and introduced prehypertension.
- Population data indicates 41.8% normal BP, 31% prehypertension, and the rest hypertension in US adults.
- These population BP distributions may differ in family medicine settings.
Purpose of the Study:
- To determine the prevalence of normal BP, prehypertension, and hypertension in a family medicine practice.
- To identify characteristics associated with normal BP among adult patients.
Main Methods:
- Reviewed demographic and BP data for 633 nonpregnant adults at a family medicine clinic.
- Categorized subjects into normal BP, prehypertension, or hypertension groups.
- Utilized chi-squared tests and logistic regression to analyze factors associated with normal BP.
Main Results:
- Nearly 80% of patients had prehypertension or hypertension.
- Approximately 60% had hypertension (documented, on medication, or BP ≥ 140/90 mm Hg).
- Over 20% had prehypertension, with normal BP more common in younger, female, white, and non-overweight/obese individuals.
Conclusions:
- The prevalence of normal BP is notably low in this family medicine patient population.
- Clinicians face a dual challenge: counseling 20% of patients on prehypertension and managing hypertension in 60%.
- These findings highlight the need for adjusted clinical strategies in primary care for blood pressure management.
Background:
In 2003, the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure redefined normal blood pressure (BP) as less than 120/80 mm Hg and added the category of prehypertension, recommending that such patients receive counseling on lifestyle modifications. Based on population data, 41.8% of US adults have normal BP, 31% have prehypertension, and the remainder has hypertension. These percentages may not reflect the proportions seen in family medicine practices. The purposes of this study were to describe the proportion of adults in a family medicine practice with normal BP and the proportions with prehypertension and hypertension and to examine associations with having normal BP.
Methods:
Records of 633 nonpregnant adults from a large family medicine clinic were reviewed for demographic and BP information. Proportions of subjects in each BP category (normal, prehypertension, or hypertension) were determined. Characteristics associated with normal BP were examined using chi(2) tests and logistic regression.
Results:
Nearly 80% of adults in this population had prehypertension or hypertension. Subjects more likely to have normal BP were young, female, white, and not overweight/obese. Almost 60% of subjects had documented hypertension, were receiving antihypertensive medications, or had a BP on the day of visit > or = 140/90 mm Hg. Over 20% had prehypertension.
Conclusion:
The proportion of adult family medicine patients with normal BP is low. Counseling 20% of adult patients about prehypertension while continuing to strive to improve BP control for the 60% of patients with hypertension could pose a new challenge to clinicians working in family medicine offices.
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