Screening for High Blood Pressure in Adults During Ambulatory Nonprimary Care Visits: Opportunities to Improve Hypertension Recognition

Abstract

Visits with nonprimary care providers such as optometrists may be missed opportunities for the detection of high blood pressure (BP). For this study, normotensive adults with at least 12 months of health plan membership on January 1, 2009 (n=1,075,522) were followed-up for high BP through March 14, 2011. Of 111,996 patients with a BP measurement ≥140/90 mm Hg, 82.7% were measured during primary care visits and 17.3% during nonprimary care visits. Individuals with a BP ≥140/90 mm Hg measured during nonprimary care visits were older and more likely to be male and non-Hispanic white. The proportion of patients with follow-up and false-positives were comparable between primary and nonprimary care. The main nonprimary care specialty to identify a first BP ≥140/90 mm Hg was ophthalmology/optometry with 24.5% of all patients. Results suggest that expanding screening for hypertension to nonprimary care settings may improve the detection of hypertension.

Figure 1

Study flow chart. *History of high blood pressure (BP) is defined as any outpatient visits with a BP ≥140/90 mm Hg, any inpatient or outpatient diagnosis (Dx) code for hypertension (HTN) defined as International Classification of Disease, Ninth Revision (ICD ‐9 401‐405 or 362.1), or any prescription (Rx) for an antihypertensive medication within 24 months prior to January 1, 2009. KPSC indicates Kaiser Permanente Southern California.