Factors Associated With Discussing High Blood Pressure Readings in Clinical Notes.

Area of Science:

• Clinical Medicine
• Health Informatics
• Cardiovascular Health

Background:

• Blood pressure (BP) is routinely measured during healthcare visits.
• High blood pressure (HBP) measurements are frequently not documented in clinical notes.
• Understanding factors influencing HBP discussion is crucial for patient care.

Purpose of the Study:

• To identify patient and visit-level factors associated with the discussion of high blood pressure (HBP) measurements in clinical notes.
• To analyze documentation practices for HBP among patients without a prior hypertension diagnosis.

Main Methods:

• Utilized electronic medical records from 2016-2022 for patients with BP readings >= 140/90 mmHg.
• Excluded patients with any prior hypertension diagnosis.
• Employed a multi-level regression model to assess factors influencing HBP discussion in clinical notes.

Main Results:

• Out of 278,766 outpatient visits, 61,739 had HBP; only 31% were discussed in notes.
• Even in primary care, HBP was discussed in only 70% of relevant visits.
• Fever, external injury/pain, and multiple comorbidities decreased HBP discussion odds; prior HBP discussion increased odds.

Conclusions:

• Discussion of high blood pressure (HBP) in clinical notes is significantly underrepresented.
• Improving documentation of HBP can mitigate diagnostic inertia and improve hypertension management.
• Targeted interventions may be needed to ensure consistent HBP discussion in clinical notes.