Journal of Hypertension: Open Access

The Proportion of Physician Notes Addressing Elevated Blood Pressure Readings Varies Dramatically across Internal Medicine Specialties

Abstract

Samuel David Zetumer1, Philip M. Polgreen1, Manish Suneja1, Cole G. Chapman2 and Linnea A. Polgreen2*

Background: Both diagnostic and therapeutic inertia are important barriers to Blood Pressure (BP) control. BP readings are routinely measured and recorded at most healthcare visits. Thus, there are many opportunities to diagnose hypertension and improve BP control. The objective of this study was to determine the percentage of patients with elevated BP measurements where BP or hypertension is mentioned in the clinical notes.

Methods: We randomly selected outpatient visits for 10,000 patients in Internal Medicine clinics (1-1-2017 to 6-30-2021) and recorded if there was a BP value ≥ 140/90 mm Hg. The Assessment and Plans (A/Ps) from these clinic visits were extracted using a rule-based pattern-matching algorithm. A/Ps with no matching text pattern indicating BP or hypertension was considered not to have addressed hypertension. The percentage of visits where BP was mentioned was calculated for each specialty.

Results: Among the 10,000 patients, we found 5,674 clinic visits where patients had elevated BP. A/Ps from nephrology, cardiology and general internal medicine visits mentioned elevated BP at least 50% of the time. In contrast, A/Ps from encounters with allergy/immunology, endocrinology (not diabetes clinic) and rheumatology specialists referenced the patient’s BP less than 10% of the time.

Conclusions: We demonstrate widespread deficiencies in the discussion of hypertension and BP in clinical notes across medical specialties.