A RETROSPECTIVE CHART REVIEW ANALYZING THE RELATIONSHIP BETWEEN BLOOD PRESSURE RECHECKS AND POLYPHARMACY
Research Mentor Name
Dr. Danielle Heidemann and Dr. Meghan K Gwinn
Research Mentor Email Address
Institution / Department
Henry Ford Health System / Internal Medicine
Level of Research
Background: Hypertension (HTN) affects nearly 80 million people in the United States. A patient’s blood pressure (BP) measurement may influence the number of antihypertensives prescribed. Providers often do not recheck BP when a patient’s measurement is elevated despite research supporting that remeasuring may result in a significant decrease in BP. We hypothesized that patients who have BP remeasured in clinic would have lower BP values and thus less antihypertensive medication. In our academic general internal medicine (GIM) clinic, providers are encouraged to manually repeat BP if elevated on vitals taken by medical assistants using an automated cuff at check-in. Our aim was to determine if repeating BP in patients with uncontrolled HTN is associated with a reduced number of antihypertensive medications. Our secondary aims were to assess the frequency at which BP is rechecked and to determine if there were disparities in provider or patient factors in whom BP was repeated.
Methods: We performed a retrospective chart review on patients between the age of 18-85 with a hypertension diagnosis who were seen at our urban academic GIM clinic between 01/01/2019 and 12/31/2019. Individuals with ESRD and HF were excluded. We collected data including age, BP readings, provider type (resident or senior staff), gender, race, time of appointment, BMI, and comorbidities.
Results: A total of 2259 patients met the inclusion criteria. The mean age was 59.8 years, BMI was 33.2, first systolic BP was 153.7 mmHg, and first diastolic BP was 89.3 mmHg. A total of 1301 (58%) patients were seen by a trainee, 1307 (57%) were seen in the morning, 1287 (57%) were female, and 1885 (83%) were black. A total of 929 (41%) patients had their BP rechecked. The mean antihypertensives prescribed in the group with BP rechecked was 2.3 medications, compared to 2.4 medications in those whose BP was not rechecked (p-value= 0.3241). There was no significant difference between provider or trainee rechecking BP (p-value=0.3425), race of patient (p-value=0.9863), and age of patient (p-value=0.0896). Morning appointments (p-value=0.0009), Males (p-value=0.0445), less obese patients (p-value=0.0188), and patients with COPD (p-value=0.0170) were more likely to be rechecked. When comparing the first and second BP measurement, 82.56% systolic and 72.23% of diastolic measurements improved with an average of a 10.7 systolic decrease and a 5.1 diastolic decrease.
Conclusions: Rechecking BP in patients with uncontrolled HTN was associated with a decrease in BP. However, rechecking BP was not associated with a reduction in antihypertensive medications in patients with uncontrolled BP. Numerous factors were associated with a decreased likelihood of BP remeasurement including high BMI, female patients, and later appointment times.
Learning Objective #1: Rechecking BP in patients with uncontrolled HTN leads to decreased BP readings in clinic.
Learning Objective #2: Rechecking BP in clinic is not associated with a reduction in antihypertensive medications in patients with uncontrolled HTN.
Medicine and Health Sciences | Quality Improvement
Bartkowiak, Callie M.; Gwinn, Meghan K.; and Heidemann, Danielle, "A RETROSPECTIVE CHART REVIEW ANALYZING THE RELATIONSHIP BETWEEN BLOOD PRESSURE RECHECKS AND POLYPHARMACY" (2023). Medical Student Research Symposium. 189.