Abstract 134: Blood Pressure Control And Hypertension Diagnosis Six Months After Completing Ambulatory Blood Pressure Diagnostic Testing

Abstract

Importance: Undiagnosed hypertension contributes to excess morbidity and mortality. Objective: To examine the effect of hypertension diagnostic testing on hypertension diagnoses and blood pressure (BP) control months at 6 months. Design, Setting, and Participants: BP CHECK was a randomized diagnostic study of 510 adults aged 18-85 without diagnosed hypertension with elevated BP in clinic and at baseline, conducted from 2017 to 2019 in primary care centers of an integrated healthcare system. Participants were randomization to one of three diagnostic regimens: (1) Clinic BP, (2) Home BP, or (3) Kiosk BP. All participants completed 24-hour ambulatory blood pressure monitoring (ABPM) at 3 weeks. ABPM results were sent to participants and their primary care providers and uploaded into the electronic health records (EHR). Main Outcomes and Measures: The primary outcomes were BP control and receipt of a new hypertension diagnosis at 6 months. We further examined whether changes in patient-reported outcomes relating to health behaviors or 6-month health attitudes were associated with BP control or a new hypertension diagnosis. Results: Mean baseline BP was 150/88 mmHg. Among 467 study participants completing ABPM, 335 (72%) were confirmed to have hypertension. At 6 months, 47% (156/335) of participants with hypertension achieved BP <140/90 mmHg and 41% (137/335) had a new hypertension diagnosis recorded in the EHR with no differences by randomized group. Participants with a new hypertension diagnosis (n=137) experienced significantly greater reductions from baseline in systolic and diastolic BP (mean difference, -4.9 mmHg [95% CI: -7.8,-2.1]) and diastolic BP (-2.3 mmHg [-4.3, -0.4]) compared to individuals with undiagnosed hypertension (n=198). Significantly higher proportions of participants with adequate BP control and diagnosed hypertension felt sharing home BP readings with their provider was helpful or very helpful in managing their BP. Conclusion and Relevance: Most participants with high BP on screening and ABPM diagnostic testing did not achieve adequate BP control or receive a hypertension diagnosis within 6 months. New strategies are needed to increase diagnosis of hypertension in clinical practice