Related Experiment Videos
Hospitalization as an opportunity to improve hypertension recognition and control
P Greenland1, J C Levenkron, R M Smith
1Department of Medicine, University of Rochester School of Medicine and Dentistry, New York.
Insights
Hospitalization offers a chance to manage high blood pressure (hypertension), but care gaps persist. Many patients leave the hospital with uncontrolled hypertension or a missed diagnosis, indicating room for improvement in inpatient hypertension management.
Area of Science:
- Cardiology
- Internal Medicine
- Health Services Research
Background:
- Hospitalization presents a key opportunity for optimizing hypertension management and patient follow-up.
- Current hypertension care during hospitalization may not fully align with established guidelines, such as those from the Joint National Committee (JNC) reports.
Purpose of the Study:
- To evaluate the quality of hypertension-related medical care provided to hospitalized patients.
- To assess whether hospitalization effectively leads to improved hypertension control and diagnosis based on JNC III guidelines.
Main Methods:
- Retrospective review of medical and surgical patient records (n=536) admitted to a university hospital.
- Analysis of hypertension control status at admission and discharge.
- Comparison of care between medical and surgical patient groups.
Main Results:
- Of 143 hypertensive patients, 70% were controlled on admission, and 77% at discharge.
- Surgical patients were significantly more likely than medical patients to be discharged without a documented hypertension diagnosis (P < 0.05).
- 44% of patients admitted with uncontrolled hypertension remained uncontrolled at discharge; no significant increase in antihypertensive drug use was observed.
Conclusions:
- Physicians often miss opportunities during hospitalization to diagnose and control hypertension.
- Surgeons may be less diligent than internists in diagnosing hypertension among hospitalized patients.
- Inpatient settings represent a crucial, yet underutilized, venue for enhancing hypertension care and control.
Abstract:
Hospitalization may afford an excellent opportunity to maximize recognition and control of the hypertensive patient and ensure medical follow-up. We reviewed records of 536 medical or surgical patients consecutively admitted to a university hospital to assess trends in hypertension-related medical care according to guidelines established by the 1984 report of the Joint National Committee (JNC III) on Hypertension Detection, Treatment, and Control. Of 143 hospitalized patients considered hypertensive, 70% were controlled on admission, and 77% were controlled at hospital discharge. No significant differences were found in control status when medical and surgical patients were compared. Of 52 medical patients with hypertension, two lacked a documented diagnosis of hypertension at discharge compared to 16 of 94 surgical patients with hypertension (P less than 0.05). Nine of the 16 undiagnosed surgical patients were also uncontrolled at discharge. Of 43 medical or surgical patients who entered the hospital uncontrolled, 19 (44%) remained uncontrolled at discharge. Seventy percent of patients with uncontrolled hypertension entered the hospital on antihypertensive drugs, and there was no net increase in antihypertensive drug use in these patients during hospitalization. These data suggest that physicians frequently fail to capitalize on hospitalization as an opportunity to diagnose and control hypertension in some patients. Our results indicate that surgeons may be less attentive than internists to diagnosis of hypertension. In addition, hospitalization remains a setting in which medical care for hypertension could be improved.