Basic Initial Diagnostic Workup for Newly Diagnosed Hypertensives

From the 2021 HVPAA National Conference

Michael Rubinson (Crozer Chester Medical Center), Anila Hussain, Nadia Aslam, Christopher Capicotto

Background

Hypertension is widespread across the United States, affecting nearly one in every three adults over the age of twenty. In November 2017, the ACC and AHA (among many other organizations) published a new Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. Guidelines outlined basic tests to establish a baseline for medication use, and screen for secondary causes of hypertension. These tests include: fasting blood glucose, complete blood count (CBC), basic metabolic panel (BMP), lipid profile, thyroid-stimulating hormone (TSH), urinalysis (UA), and electrocardiogram (ECG).

Objective

The primary objective of this study is to assess the diagnostic workup for newly diagnosed hypertensive patients at a primary care outpatient office, as outlined in the 2017 ACC/AHA Guidelines. Our secondary objective was to also evaluate the knowledge of our house staff physicians as it pertains to the new guidelines.

Methods

This retrospective, cross-sectional, single-center study was done at a teaching primary care office in Upland, PA. 1,052 patient charts were reviewed, and of those, 206 patients were included in the study. The inclusion criteria consisted of patients diagnosed with hypertension between April 2018 and November 2019. Patients diagnosed outside of that time frame, and those with a diagnosis of “elevated blood pressure were excluded. Patient charts were evaluated for CBC, fasting blood glucose, BMP, lipid profile, TSH, UA, and ECG at the time of diagnosis. Patients with these tests within 9 months of diagnosis, and patients coming from a recent hospital visit with these tests done, were counted as having the tests, as long as it was documented during the visit.

Results

206 patients were included in our study, 111 were new to the practice, and 95 were already established. Of the new patients to the practice, 54.1% (60/111) received a CBC, 68.5% (76/111) received a lipid profile, 8.1% (9/111) received a fasting glucose, 29.7% (33/111) received a TSH, 20.7% (23/111) received a UA, and 13.5% (15/111) received an ECG. Of established patients, 57.9% (55/95) received a CBC, 76.8% (73/95) received a lipid profile, 27.4% (26/95) received a fasting blood glucose, 30.5% (29/95) received a TSH, 22.1% (21/95) received a UA, and 26.3% (25/95) received an ECG. On average of the two groups, 55.8% (115/206) received a CBC, 77.2% (159/206) received a BMP, 72.3% (149/206) received a lipid profile, 27.4% (56/206) received a fasting blood glucose, 30.1% (62/206) received a TSH, 21.4% (44/206) received a UA, and 19.4% (40/206) received an ECG. Among house staff, 66.7% were aware of BP goal as outlined in Hypertension guidelines, whereas 70.8% were aware of lab testing as part of guidelines.

Conclusion

Results showed a low percentage of patients received fasting blood glucose, TSH, UA, and an ECG. Knowledge among house staff is above fifty percent but with lots of room for improvement. Inadequate lab testing on a newly diagnosed hypertensive patient can lead to missing many causes of hypertension, and thus not possessing the information to direct therapy.

Clinical Implications

This Study Improved knowledge of HTN guidelines in newly diagnosed patients amongst house staff and emphasized the importance of proper workup for early recognition and treatment of reversible causes as well as to help direct the management depending on underlying risk factors thus improving the quality of care provided at our outpatient office.

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