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Prehypertension and hypertension in a primary care practice

Andrea Pike, MSc and Allison Kirby, MA
Research assistants at the Primary Healthcare Research Unit at Memorial University of Newfoundland

Carolyn Jewer and Laura Murphy, MSc
Ms Jewer is a third-year medical student and Ms Murphy is a medical student at Memorial University of Newfoundland

Correspondence: Dr Marshall Godwin, Memorial University of Newfoundland, Health Sciences Centre, Room 1776, 300 Prince Phillip Dr, St John’s, NL A1B 3V6; telephone 709 777-8373; fax 709 777-6118; e-mailgodwinm{at}mun.ca

OBJECTIVE To assess the prevalence of prehypertension and the prevalence and treatment of hypertension in a family practice population.

DESIGN Cross-sectional study.

SETTING An academic family practice unit.

PARTICIPANTS Practice patients aged 30 to 80 years who had visited the clinic at least once during the 2 years before the study and had at least 1 blood pressure (BP) measurement recorded on their charts during that time period.

MAIN OUTCOME MEASURES Most recent BP recorded on the chart; presence or absence of a diagnosis of hypertension recorded on the chart; number and class of prescribed antihypertensive medications.

RESULTS Of the 1388 patients who met the inclusion criteria, 389 had a diagnosis of hypertension. Of the 999 who did not have a diagnosis of hypertension, 306 (30.6%) met the criteria for prehypertension used in this study (systolic BP of 130 to 139 mm Hg or diastolic BP of 85 to 89 mm Hg). Men and older patients (60 to 80 years of age) were more likely to have prehypertension than other patients were. Of the patients with hypertension, 254 (65%) had achieved a BP level of < 140/90 mm Hg. The majority of hypertensive patients were prescribed 1 or 2 medications. Only 4.5% were using more than 2 different medications.

CONCLUSION A large proportion of a family practice’s patients need close surveillance of BP because of the prevalence of prehypertension. Despite the improvement in the management of hypertension, only 65% of hypertensive patients had achieved the recommended target BP. Family physicians could be treating their hypertensive patients more aggressively with medications; only 4.4% of patients were using more than 2 different antihypertensive medications, despite 35% not being at target. Hypertension surveillance and treatment to achieve target BP levels continue to be important issues in primary care.

This article has been cited by other articles:

				M. Godwin, R. Birtwhistle, R. Seguin, M. Lam, I. Casson, D. Delva, and S. MacDonald Effectiveness of a protocol-based strategy for achieving better blood pressure control in general practice Fam. Pract., February 1, 2010; 27(1): 55 - 61. [Abstract] [Full Text] [PDF]