The following is a summary of “Blood pressure measurements for diagnosing hypertension in primary care: room for improvement,” published in the January 2024 issue of Primary Care by Voorbrood, et al.

Approximately 50% of the adult population has hypertension, a significant cardiovascular disease risk factor. However, there needs to be more understanding of the quality of hypertension diagnosis methods in primary care. For a study, researchers sought to evaluate the frequency of recognized methods for diagnosing hypertension, focusing on whether three distinct measurements were taken, particularly for office blood pressure measurements (OBPM), and to assess the accuracy of blood pressure level interpretation.

A retrospective population-based cohort study was conducted using electronic medical records of patients aged 40 to 70, presenting with new-onset hypertension in 2012, 2016, 2019, and 2020. A visual chart review of a random sample of 500 patients assessed the methods used for hypertension diagnosis. Completeness of blood pressure measurement methods required three or more valid OBPM, home-based blood pressure measurements (HBPM), office-based 30-minute method (OBP30), or 24-hour ambulatory blood pressure measurements (24 H-ABPM).

OBPM was the most frequently used method across study years. OBP-30 was used in 0.4% (2012), 4.2% (2016), 10.6% (2019), and 9.8% (2020). 24 H-ABPM was used in 16.0%, 22.2%, 17.2%, and 19.0%, and HBPM in 5.4%, 8.4%, 7.6%, and 7.8%, respectively. A diagnosis based on one or two office measurements occurred in 85.2% (2012), 87.9% (2016), 94.4% (2019), and 96.8% (2020). In cases of incomplete measurement and incorrect interpretation, medication was initiated in 64% (2012), 56% (2016), 60% (2019), and 73% (2020).

OBPM remained the predominant method for hypertension diagnosis in primary care, often being incomplete or misinterpreted. While slight improvement occurred between 2012 and 2016, progress stalled in 2019 and 2020. Inappropriately diagnosed hypertension may lead to under-treatment or prolonged, unnecessary treatment, indicating the need for improvement in general practice settings.

Source: bmcprimcare.biomedcentral.com/articles/10.1186/s12875-023-02241-z