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The management of pre-hypertension in primary care: Is it adequate?
A Grossman1, Ofir Ben-Assuli, S Zelber-Sagi
1Institute of Endocrinology and Metabolism , Petah Tikva , Israel.
Insights
Primary care physicians (PCPs) do not significantly alter follow-up for patients with pre-hypertension (pHT), even with elevated blood pressure (BP) readings. This suggests current management strategies for pHT in primary care settings require further evaluation.
Area of Science:
- Cardiology
- Primary Care Medicine
- Public Health
Background:
- Pre-hypertension (pHT) is a common diagnosis in primary care.
- The management of pHT by primary care physicians (PCPs) is not well understood.
Purpose of the Study:
- To characterize the follow-up management of pre-hypertension by PCPs.
- To investigate if the identification of pHT leads to changes in patient follow-up protocols.
Main Methods:
- A retrospective study evaluated 20,214 individuals aged 30-45 years with blood pressure (BP) measurements between 2006-2010.
- Individuals were categorized into optimal, normal, and pre-hypertension (borderline) BP groups.
- Follow-up visits and repeat BP measurements by PCPs were compared across groups.
Main Results:
- 32.5% of individuals had pre-hypertension (pHT).
- Follow-up visits and BP measurements were similar for optimal BP and pHT groups.
- While a third and fourth BP measurement were more frequent in the pHT group, the overall follow-up intensity did not significantly change.
Conclusions:
- Identifying pre-hypertension (pHT) does not significantly alter the follow-up intensity by primary care physicians (PCPs).
- Management of pHT in primary care settings appears consistent regardless of the specific blood pressure values within the pHT range.
Background:
Pre-hypertension (pHT) is frequently diagnosed in the primary care setting, but its management by primary care physicians (PCPs) is not well characterized.
Methods:
All individuals aged 30-45 years who were insured by Clalit Health services in the Tel Aviv district and had their blood pressure (BP) measured from January 2006 to December 2010 were evaluated. Individuals were divided into three groups based on their initial BP value: optimal (< 120/80 mmHg), normal (systolic BP 120-129 or diastolic 80-84 mmHg) and borderline (130-139/85-89 mmHg). Groups were compared regarding clinical and laboratory follow-up performed by their PCP.
Results:
Of the 20,214 individuals included in the study, 6576 (32.5%) had values in the pHT range. Of these, 2126 (32.3% of those with pHT) had BP values defined as "borderline" and 4450 (67.6% of those with pHT) had BP values defined as "normal". The number of follow-up visits by the PCP and repeat BP measurement were similar in those with "optimal" BP and pHT. A third and fourth BP measurement were recorded more frequently in those with pHT. In those with pHT, there were more recorded BP measurements than in those with borderline BP (3.35 ± 3 vs. 3.23 ± 2.6), but the time from the initial to the second measurement and a record of a third and fourth measurement were the same in the two groups.
Conclusion:
Identification of pHT does not lead to a significant change in follow-up by PCPs, irrespective of BP values in the pHT range.
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