Hypertension Underdiagnosed in Young Adults in Primary Care

Major Finding: Young adults aged 18-31 years with high blood pressure who were regular users of primary care services were roughly 27% less likely to receive a diagnosis of hypertension within 4 years than affected patients aged 60 years or older.

Data Source: Data are from an analysis of the electronic medical records of 13,593 patients who met national guideline criteria for a hypertension diagnosis and regularly used primary care services in a large multispecialty academic group practice.

Disclosures: Dr. Johnson reported having no relevant financial disclosures.



LOS ANGELES – Young adults with high blood pressure who regularly saw a primary care physician were substantially less likely to receive a hypertension diagnosis than were older affected patients – and some of the reasons for the greater delay in initial diagnosis are eye opening, said Dr. Heather M. Johnson.

The 18- to 31-year-olds met standard diagnostic criteria for hypertension. Their regularly elevated blood pressure measurements were dutifully entered into their medical records. Yet in a study conducted in a large multispecialty academic group practice, the majority of hypertensive young adults remained undiagnosed after 4 years of regular utilization of primary care, she reported at the annual scientific sessions of the American Heart Association.

That’s consistent with findings from other studies showing that young adults with hypertension have lower rates of diagnosis and hypertension control than middle-aged and elderly patients with high blood pressure, Dr. Johnson noted. Her study went farther, however, exploring possible explanations for the disparity.

The study involved analysis of the electronic medical records of 13,593 patients aged 18 years or older, all of whom regularly utilized primary care services during 2008-2011 and fulfilled national guideline–based criteria for the diagnosis of hypertension.

After 4 years of regular primary care, 67.4% of 18- to 24-year-olds with clear evidence of hypertension in their charts remained undiagnosed. So did 65% of affected 25- to 31-year-olds. These rates were significantly higher than in the older hypertensive patients seen in primary care.

Indeed, after 4 years, 18- to 24-year-olds with high blood pressure were 28% less likely to have received an initial hypertension diagnosis than were affected adults aged 60 years or older. Affected 25- to 31-year-olds were 26% less likely to have been diagnosed than patients aged 60 and up. These results were adjusted statistically for age, sex, race, body weight, primary spoken language, comorbid conditions, provider specialty, and other variables, explained Dr. Johnson, a cardiologist at the University of Wisconsin, Madison.

Rates of undiagnosed hypertension declined steadily with advancing age. Nonetheless, 54% of hypertensive patients aged 60 or older remained undiagnosed after 4 years, despite the objective evidence in their charts.

Intriguingly, the average time to diagnosis for patients whose hypertension was diagnosed within 4 years didn’t vary significantly by age: It was 5-6 months, regardless, she added.

Dr. Johnson pointed to provider, patient, and health care system factors as all being critical determinants of the poor rates of hypertension diagnosis among young adults.

One key independent predictor of delay to initial hypertension diagnosis in young adults identified in her multivariate analysis was patient race. Black young adults with hypertension were 39% more likely to have received the diagnosis than white patients.

"African Americans are known to have a higher prevalence of hypertension and its comorbidities, especially at younger age groups. Our data suggest providers are aware of this," Dr. Johnson said.

Young adults who were current users of tobacco or were regularly exposed to secondhand smoke were 29% less likely than never users to have their hypertension diagnosed.

Those with baseline blood pressures of 140-159/90-99 mm Hg were 35% less likely to receive a hypertension diagnosis within 4 years than those with baseline readings of 160-179/100-109 mm Hg.