EHR Data Analysis Suggests Need for Improvement in Blood Pressure Management

A study from PCORnet Blood Pressure Control Laboratory (BP Control Lab), an electronic platform for analyzing nationally-collected data on blood pressure control metrics, utilized the health records of approximately 1.5 million patients with high blood pressure in order to evaluate the efficacy of blood pressure management and control strategies in the United States and found several shortcomings.

The findings were presented at the 2020 American Heart Association’s Epidemiology and Prevention | Lifestyle and Cardiometabolic Health Scientific Sessions, which took place from March 3 to 6 in Phoenix, Arizona.

Eligible patients completed a total of 5.8 million clinic visits over the course of 1 year. The average age of participants was 62 years, and 10% were younger than 45. The demographics of the patients was 18% African American, 52% female, 28% with diabetes, 15% with heart disease, and 14% with depression.

BP Control Lab analyzed information from 23 electronic health record (EHR) datasets and found that 60% of the 1.5 million participants had blood pressure controlled to below 140/90 mmHg; of those, many did not receive a change in dose or a different medication in response to their high BP reading.

The analysis of blood pressure management showed that some recommended guidelines from the American College of Cardiology/American Heart Association were being largely ignored, including taking a second reading to confirm that a patient’s blood pressure is high, and making adjustments to BP medications and/or doses when a patient shows a high reading. Only 22% of visits included a second BP reading when results were high, and a slim 12% of participants received orders for a new class of blood pressure-lowering medications.

Studies have demonstrated and clinicians stress that blood pressure management guidelines and recommendations offer effective results and should be followed, especially since high blood pressure is a preventable condition. When clinicians perform the recommended guidelines, an average blood pressure reduction of 15 mmHg followed.

Rhonda M. Cooper-DeHoff, PharmD, MS, lead study author and associate professor in the College of Pharmacy at the University of Florida in Gainesville, Florida, echoed the sentiment of improving alignment to guidelines. She said, “We were particularly struck by the low rates of medication intensification when blood pressure is found to be high during a clinic visit––if we can improve medication prescribing rates, our data suggest we could make a big difference in blood pressure control.”

References:

1. New “real world” data reveal potential opportunities for blood pressure improvement [news release]. American Heart Association’s website. https://newsroom.heart.org/news/new-real-world-data-reveal-potential-opportunities-for-blood-pressure-improvement?preview=1795. Accessed March 9, 2020.