Differences in diagnosis and treatment rates between systolic and diastolic hypertension among young adults

Abstract

Background: Less than 50% of young adults with hypertension have achieved control. Understanding hypertension diagnosis and treatment patterns in primary care will help tailor young adult hypertension interventions. The objective was to compare the rates of receiving an initial hypertension diagnosis and antihypertensive prescription between young adults with 1) isolated systolic, 2) isolated diastolic, and 3) combined systolic/diastolic hypertension. Methods: This retrospective analysis examined 18-39 year-olds with incident hypertension receiving regular primary care in a large academic group practice from 2008-2011. Eligible patients met JNC7 criteria for a hypertension diagnosis and antihypertensive prescription. The average of the last two blood pressures prior to study entry defined the hypertension type. Patients with a previous hypertension diagnosis or antihypertensive prescription were excluded. Kaplan-Meier survival curves were computed for systolic, diastolic, and combined systolic/diastolic hypertension to evaluate the probability of receiving: 1) a hypertension diagnosis and 2) an antihypertensive prescription, as a function of time since meeting hypertension criteria. Cox proportional hazards regression analysis was used to obtain adjusted hazard ratios and 95% confidence intervals (HR; 95% CI). Results: Among 3,525 young adults, 37% had isolated systolic hypertension, 32% isolated diastolic, and 31% combined systolic/diastolic. At 48 months, 69% with combined systolic/diastolic received an initial diagnosis, compared to 55% (isolated diastolic) and 52% (isolated systolic). At 48 months, 59% with combined systolic/diastolic received an initial antihypertensive prescription, compared to 44% (isolated diastolic) and 30% (isolated systolic). After adjusting for patient and provider factors, young adults with combined systolic/diastolic were 70% more likely (HR: 1.7; 1.5-2.1) to receive a diagnosis compared to isolated systolic. Isolated diastolic (HR: 1.3; 1.1-1.6) and combined systolic/diastolic (HR: 2.4; 2.0-2.9) patients were more likely to receive an antihypertensive prescription compared to isolated systolic patients. Conclusions: Hypertension diagnosis and treatment in young adults was less likely with isolated systolic hypertension. Primary care interventions aimed at diagnosis and treatment variation may improve hypertension control in young adults.