Key result
Documented blood pressure mentions in clinical notes are linked to ~74% higher timely hypertension diagnosis rates.
Why the study?
Diagnostic delays contribute to uncontrolled hypertension, leading to increased morbidity, mortality, and costs, but the duration of these diagnostic delays in the US remains to be estimated.
Does specific clinical documentation of elevated BP and the occurrence of primary-care visits reduce delays in the formal diagnosis of hypertension in patients with documented high blood pressure?
Cohort (n=7,744)
No
Does specific clinical documentation of elevated BP and the occurrence of primary-care visits reduce delays in the formal diagnosis of hypertension in patients with documented high blood pressure?
Diagnostic inertia for hypertension is severe, but increasing primary care follow-up and explicitly documenting elevated blood pressure in clinical notes significantly reduces delays in formally diagnosing the condition.
Provider notes on high BP may facilitate timelier diagnosis; extends observational data but leaves open causality and needs prospective validation.
INTRODUCTION: Diagnostic delays contribute to uncontrolled hypertension, leading to increased morbidity, mortality and costs. The goal of this study was to estimate the duration of delays in the diagnosis of hypertension that contribute to uncontrolled hypertension in the US. METHODS: We collected data from the electronic health record for University of Iowa Healthcare from 2016 to 2022 for all patients with any BP record of 130/80 mmHg or greater but without an initial hypertension diagnosis. We used a Cox Proportional Hazards Model to determine the length of diagnostic delay as well as risk factors for delay. We specifically examined the presence of provider notes discussing BP or hypertension. RESULTS: Only 5% of our cohort with BP readings of 130/80 mm Hg or greater were diagnosed with hypertension at the first visit. At one month, 7.4% were diagnosed, 10% within 3 months, increasing to 14% at 12 months. Most patients remained undiagnosed after at 12 months and 75% remained undiagnosed at 5 years. Shorter delays were associated with higher BP values, prior diagnoses of "high BP, not hypertension" and prior clinical notes discussing BP or hypertension. Shorter delays were also associated with other cardiovascular diagnoses, primary-care visits and inpatient stays. CONCLUSIONS: Our findings highlight the large number of missed opportunities to diagnose hypertension and demonstrate compelling reasons for improving clinical documentation related to high BP readings and increasing primary-care visits.
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Chapman et al. (2025) conducted a cohort in Undiagnosed high blood pressure (n=7,744). Clinical notes discussing high blood pressure or hypertension vs. No clinical notes mentioning high blood pressure or hypertension was evaluated on Time to hypertension diagnosis (HR 1.74, 95% CI 1.57-1.92). The presence of clinical notes mentioning high blood pressure or hypertension was associated with a higher likelihood of receiving a timely hypertension diagnosis (HR 1.74).
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