Validity of self-reported blood pressure control in people with hypertension attending a primary care center
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Marianne E Gee1, William Pickett, Ian Janssen
1Departments of aPublic Health Sciences bEmergency Medicine cFamily Medicine dSchool of Kinesiology and Health Studies, Queen's University, Kingston, Ontario eDepartments of Medicine, Community Health Sciences and of Physiology and Pharmacology, Libin Cardiovascular Institute, University of Calgary, Calgary, Canada.
Insights
Self-reported blood pressure control is often inaccurate, with many patients overestimating their control. This suggests self-reports may not be reliable for assessing hypertension management in clinical or survey settings.
Area of Science:
- Cardiovascular Health
- Public Health
- Clinical Epidemiology
Background:
- Hypertension management relies on accurate blood pressure monitoring.
- Self-reported data is frequently used in health surveys and clinical assessments.
- The validity of self-reported blood pressure control needs evaluation, especially in diverse patient groups.
Purpose of the Study:
- To assess the accuracy of self-reported blood pressure control and medication adherence.
- To compare self-reported data with objective clinical indicators in hypertensive patients.
- To investigate the validity of self-reported hypertension control in patients with and without diabetes.
Main Methods:
- A study involving 161 hypertensive patients from a family health team in Ontario.
- Utilized questions from the 2009 Survey on Living with Chronic Disease in Canada Hypertension Component.
- Compared self-reported data against objectively measured blood pressure and chart-abstracted medication records.
Main Results:
- Self-reported blood pressure control demonstrated good sensitivity but poor specificity, particularly in patients without diabetes.
- Specificity improved for diabetic patients when a higher blood pressure target was used.
- Fair agreement was observed between self-reported and chart-abstracted medication counts, with notable over- and underestimation by patients.
Conclusions:
- A significant number of patients with uncontrolled hypertension inaccurately reported controlled blood pressure.
- Self-reported measures of blood pressure control may lack utility for accurate hypertension assessment in family medicine and health surveys.
- Misclassification of hypertension control based on self-report highlights the need for objective measurement.
Objectives:
The aim of this study was to estimate the validity of self-reported blood pressure control and medication use in people with hypertension, with and without diabetes.
Methods:
In a sample of 161 patients with hypertension in a family health team in Ontario, we applied questions from the 2009 Survey on Living with Chronic Disease in Canada Hypertension Component and compared responses against objectively measured and chart-abstracted clinical indicators. Objective blood pressure control was defined as a blood pressure of less than 130/80 mmHg and less than 140/90 mmHg for individuals with and without diabetes, respectively.
Results:
Self-reported blood pressure control showed reasonable sensitivity (83±11 and 78±10%) but low specificity (30±19 and 58±21%) in people with and those without diabetes, respectively. In the subgroup with diabetes, specificity improved to 88±11% when blood pressure control was defined on the basis of a 140/90 mmHg target. Self-reported and chart-abstracted numbers of prescribed antihypertensive medications showed fair agreement (κ=0.7); 9 and 14% of patients overestimated and underestimated the number of prescribed medications, respectively.
Conclusion:
Although most individuals with controlled hypertension reported having controlled blood pressure, a large proportion of individuals with uncontrolled hypertension also reported that their blood pressure was controlled. This level of misclassification suggests that in a family medicine clinic population and in health survey contexts, a self-reported measure of blood pressure control may not be useful for assessing hypertension control.
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