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Observational Study
. 2021 Sep 22;34(9):963-972.
doi: 10.1093/ajh/hpab070.

Estimated Prevalence of Hypertension and Undiagnosed Hypertension in a Large Inpatient Population: A Cross-sectional Observational Study

Adam Mahdi  1 , Laura C Armitage  2 , Lionel Tarassenko  1   3 , Peter Watkinson  3   4
Affiliations
Observational Study

Estimated Prevalence of Hypertension and Undiagnosed Hypertension in a Large Inpatient Population: A Cross-sectional Observational Study

Adam Mahdi et al. Am J Hypertens. .

Abstract

Background: Hypertension is a major cause of morbidity and mortality. In community populations the prevalence of hypertension, both in diagnosed and undiagnosed states, has been widely reported. However, estimates for the prevalence of hospitalized patients with average blood pressures (BPs) that meet criteria for the diagnosis of hypertension are lacking. We aimed to estimate the prevalence of patients in a UK hospital setting, whose average BPs meet current international guidelines for hypertension diagnosis.

Methods: We performed a retrospective cross-sectional observational study of patients admitted to adult wards in 4 acute hospitals in Oxford, United Kingdom, between March 2014 and April 2018.

Results: We identified 41,455 eligible admitted patients with a total of 1.7 million BP measurements recorded during their hospital admissions. According to European ESC/ESH diagnostic criteria for hypertension, 21.4% (respectively 47% according to American ACC/AHA diagnostic criteria) of patients had a mean BP exceeding the diagnostic threshold for either Stage 1, 2, or 3 hypertension. Similarly, 5% had a mean BP exceeding the ESC/ESH (respectively 13% had a mean BP exceeding the ACC/AHA) diagnostic criteria for hypertension, but no preexisting diagnostic code for hypertension or a prescribed antihypertensive medication during their hospital stay.

Conclusions: Large numbers of hospital inpatients have mean in-hospital BPs exceeding diagnostic thresholds for hypertension, with no evidence of diagnosis or treatment in the electronic record. Whether opportunistic screening for in-hospital high BP is a useful way of detecting people with undiagnosed hypertension needs evaluation.

Keywords: blood pressure; hospital measurements; hypertension; undiagnosed hypertension.

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Figures

Figure 1.
Figure 1.
Inclusion/exclusion criteria flowchart.
Figure 2.
Figure 2.
Estimated age-dependent hypertension trends. Estimated prevalence trends of patients meeting the criteria for “clinic,” ABPM day, ABPM night, and ABPM 24-hour hypertension for different age groups according to the European ESC/ESH (top panel) and American ACC/AHA (bottom panel) guidelines (Supplementary Tables ST-2 online).
Figure 3.
Figure 3.
Estimated undiagnosed age-dependent hypertension trends. Estimated prevalence of undiagnosed hypertension trends for different age groups according to the European ESC/ESH (top panel) and American ACC/AHA (bottom panel) guidelines.
See this image and copyright information in PMC

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