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. 2023 May 1;41(5):751-758.
doi: 10.1097/HJH.0000000000003396. Epub 2023 Mar 3.

Seasonal variation in blood pressure control across US health systems

Ester Kim Nilles  1 , XiaoXia Champon  1 , Hillary Mulder  1 , Kathryn M Shaw  2 , Myra Smith  2 , Zachary M Lampron  1 , Gregory Wozniak  3 , Alanna M Chamberlain  4   5 , Thomas Carton  6 , Anthony J Viera  7 , Faraz S Ahmad  8 , Benjamin A Steinberg  9 , Cynthia H Chuang  10 , Kathleen M Mctigue  11 , James C McClay  12 , Tamar S Polonsky  13 , Carlos Maeztu  14 , Margaret Sanders  6 , Nate Warren  15 , Rajbir Singh  16 , Mei Liu  2 , Jeffrey J VanWormer  17 , Soo Park  18 , Madelaine Faulkner Modrow  18 , Michael Rakotz  3 , Rhonda M Cooper-Dehoff  19 , Mark J Pletcher  18 , Emily C O'Brien  1
Affiliations

Seasonal variation in blood pressure control across US health systems

Ester Kim Nilles et al. J Hypertens. .

Abstract

Objective: We aimed to characterize seasonal variation in US population-based blood pressure (BP) control and BP-related metrics and evaluate the association between outdoor temperature and BP control variation.

Methods: We queried electronic health records (EHRs) from 26 health systems, representing 21 states, to summarize BP metrics by quarters of 12-month periods from January 2017 to March 2020. Patients with at least one ambulatory visit during the measurement period and a hypertension diagnosis during the first 6 months or prior to the measurement period were included. Changes in BP control, BP improvement, medication intensification, average SBP reduction after medication intensification across quarters and association with outdoor temperature were analyzed using weighted generalized linear models with repeated measures.

Results: Among 1 818 041 people with hypertension, the majority were more than 65 years of age (52.2%), female (52.1%), white non-Hispanic (69.8%) and had stage 1/2 hypertension (64.8%). Overall, BP control and process metrics were highest in quarters 2 and 3, and lowest in quarters 1 and 4. Quarter 2 had the highest percentage of improved BP (31.95 ± 0.90%) and average SBP reduction after medication intensification (16 ± 0.23 mmHg). Quarter 3 had the highest percentage of BP controlled (62.25 ± 2.55%) and lowest with medication intensification (9.73 ± 0.60%). Results were largely consistent in adjusted models. Average temperature was associated with BP control metrics in unadjusted models, but associations were attenuated following adjustment.

Conclusion: In this large, national, EHR-based study, BP control and BP-related process metrics improved during spring/summer months, but outdoor temperature was not associated with performance following adjustment for potential confounders.

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Figures

Figure 1.
Figure 1.
Weighted BP control and BP-related process metrics over time by region, Q4-2017 – Q1-2020
Figure 2.
Figure 2.
Distributions of overall BP control and BP-related process metrics by Quarter1 1 Metric distributions are based on raw values from data.
Figure 3.
Figure 3.
Spline plots for BP control and BP-related process metrics depicting linear and non-linear relationships with average quarterly outdoor temperature1 1 Estimates and p-values are from adjusted models. BP Metric result=Averagetemperature+Region+Year+Race/Ethnicity+Sex+Age+Diabetes+Precipitation+Health System Factors+HF+CAD
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