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Implementation of the 2017 American College of Cardiology/American Heart Association Guidelines on Hypertension in

Poonam Mahato1, Rajan Ganesh2, Balaram Krishna Hanumanthu1

  • 1Department of Internal Medicine, Division of Cardiology, Mount Sinai Beth Israel/Icahn School of Medicine at Mount Sinai, New York, NY.

Ochsner Journal
|September 27, 2021
PubMed

Insights

Cardiology fellows demonstrated superior adherence to 2017 hypertension guidelines compared to internal medicine residents. This study highlights differences in applying blood pressure thresholds and treatment goals in clinical practice.

Area of Science:

  • Cardiology
  • Internal Medicine
  • Hypertension Management
  • Clinical Practice Guidelines

Background:

  • The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines define hypertension diagnosis at blood pressure (BP) ≥130/80 mmHg and treatment goal <130/80 mmHg.
  • Compliance with these updated hypertension guidelines by trainees requires assessment to ensure optimal patient care.
  • This study evaluates adherence to the 2017 ACC/AHA hypertension guidelines within internal medicine and cardiology fellowship clinics.

Purpose of the Study:

  • To assess the rate of compliance with the 2017 ACC/AHA hypertension guidelines.
  • To compare the accuracy of uncontrolled blood pressure assessment between internal medicine residents and cardiology fellows.
  • To identify factors associated with accurate hypertension management according to the latest guidelines.

Main Methods:

  • Retrospective review of medical records for patients seen in internal medicine resident and cardiology fellow clinics from January to February 2019.
  • Inclusion criteria focused on patients with BP readings of 130-139/80-89 mmHg (with specific exceptions for age, systolic BP, chronic kidney disease, and diabetes) to assess guideline adherence.
  • The primary outcome measured was the accurate assessment of uncontrolled hypertension based on the 2017 ACC/AHA guidelines.

Main Results:

  • A total of 435 patients from internal medicine clinics and 127 from cardiology clinics were analyzed.
  • Accurate assessment of uncontrolled hypertension was significantly higher in cardiology fellow clinics (29.1%) compared to internal medicine resident clinics (10.3%) (P<0.001).
  • Multivariate analysis indicated that the type of clinic (internal medicine vs. cardiology), established hypertension diagnosis, and systolic blood pressure were independently associated with accurate BP assessment.

Conclusions:

  • Cardiology fellows demonstrated significantly better performance in identifying hypertension diagnosis thresholds and treatment goals aligned with the 2017 ACC/AHA guidelines.
  • Internal medicine residents showed lower compliance rates in applying the updated hypertension guidelines.
  • These findings suggest a need for enhanced training or focused interventions to improve adherence to current hypertension guidelines among internal medicine residents.

Keywords:
Complianceguideline adherencehealth plan implementationhypertension

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