EHR, automated checks help diagnose hypertension

Using an EHR and automated office blood pressure checks together, one research team is applying 21st century solutions to the problem of diagnosing hypertension.

Published in the July issue of Annals of Family Medicine, the research team led by Michael K. Rokotz, MD, of Northwestern University’s Feinberg School of Medicine in Chicago, asked 23 primary care practices to participate in the two-phase trial.

One-third of American adults have hypertension and a further 18 percent are unaware of their condition.  With this in mind, Rokotz and colleagues developed their two phases: first, they utilized an algorithm to scan the EHR of the primary care practices for patients at risk for hypertension, collecting 1,432 candidates.

The patients then were scheduled for automated office blood pressure check measurements taken in several visits over the course of six months. The automated blood pressure checks used a device that took six readings at one-minute intervals for mean systolic and diastolic measurements.

In phase two, the patients were monitored over 24 months. They utilized physician feedback and EHR alerts to ensure further follow-up occurred with undiagnosed, at-risk patients.

Of the patients followed, 72 percent were diagnosed by the end of the trial; 361 were diagnosed with hypertension, 290 were diagnosed with white-coat hypertension, prehypertension or elevated blood pressure and 89 were considered to have normal blood pressure. Twenty-eight percent of patients remained undiagnosed at the end of the study.

Rokotz et al noted the number of office visits may have played a role in the number of undiagnosed patients. Frequency of visits had an impact on the number of patients willing to continue participation through completion, but may have ultimately lessened the predictive power of the algorithms used by the study team.

Still, Rokotz and colleagues recommended this as an alternative to home blood pressure monitoring or traditional office visits in order to diagnose hypertension in patients at risk.