Delayed diagnosis affects 14% of hypertensive patients

Delayed diagnosis is a missed opportunity

Combing medical records for 311,743 individuals who had blood pressure readings indicating hypertension, the researchers found those people didn't always get a hypertension diagnosis right away.

Rather, 14.6% of patients got their diagnosis the second time they had a blood pressure reading indicating hypertension. This trend was more common among people under age 75, women, non-Hispanic Asian and non-Hispanic Black people.

These delayed diagnoses have consequences, the researchers added. People with a delayed hypertension diagnosis had lower treatment rates and more long-term cardiovascular risks, the data showed.

The researchers did not outline how much time typically passed between the first and second blood pressure reading, meaning it's still unknown how long individuals remained undiagnosed for hypertension. A patient going one year between doctor's visits might be living that entire year with undiagnosed, and therefore unmanaged, hypertension.

However, the researchers noted that it's unlikely low patient engagement was to blame for delayed diagnoses. Indeed, patients with delayed diagnoses had just about the same number of outpatient and primary care visits as their peers with earlier diagnoses.

Instead, the researchers posited that there might be some missed clinical opportunities at play.

For example, some clinicians might be reticent to diagnose a patient hypertensive after one high blood pressure reading. There are also guidelines that suggest providers confirm sustained hypertension before starting treatment. Some also advise lifestyle modification for those with stage 1 hypertension before introducing medication.

However, the researchers observed lower rates of hypertensive medication prescriptions among those with delayed diagnoses, suggesting that these delays did not always occur because a provider was being cautious. Additionally, disparities in delayed diagnoses experienced by younger patients, women and Black or Asian patients indicates some implicit biases, the researchers suggested.

Closing the diagnosis gap

The researchers indicated that health technology could be a useful tool in closing the gap in hypertension diagnosis.

"Current clinical workflows often rely on clinician recall or manual recognition of elevated BP readings, which may be associated with oversight, particularly in busy outpatient settings," the researchers suggested. "EHR-based decision support tools could help address these challenges by systematically identifying patients who meet hypertension criteria and prompting clinicians to take action."

Tapping advanced practice providers, such as nurse practitioners, physician assistants/associates or pharmacists, could also support better wraparound chronic disease detection. These practitioners can support blood pressure re-checks, better patient education, referral to confirmation testing and support medication initiation and titration.

Still, the researchers cautioned against overdiagnosis hypertension.

"More frequent BP reassessment and ambulatory BP monitoring could help ensure that true hypertension is distinguished from temporary elevations," the research team concluded. " Integrating decision support tools with robust, interdisciplinary care teams—including physicians, nurses, and pharmacists—can improve the accuracy, timeliness, and overall quality of hypertension diagnosis and management."

Sara Heath has reported news related to patient engagement and health equity since 2015.