OAKLAND, Calif. – In a study of more than 30,000 women under the age of 50 in two large United States integrated healthcare delivery systems, researchers found that women presenting with elevated blood pressures in obstetrics-gynecology clinics were observed to have significantly lower levels of hypertension recognition, compared to women who presented with elevated blood pressures in medicine clinics.
The lower rates of hypertension recognition in obstetrics-gynecology clinics were observed among older as well as younger women, in those with higher blood pressure elevations, and in African Americans – all groups at higher risk of adverse outcomes as a consequence of untreated hypertension, said the Kaiser Permanente researchers. The study appears online in Hypertension.
The researchers explain that hypertension is routinely managed in the primary care setting. However, women access primary care differently than men and obstetrics-gynecology clinics often serve as the main source of primary health care for younger women. This study is among the first to examine the extent to which hypertension screening and other cardiovascular disease preventive care for young women is provided through obstetrics-gynecology clinics.
“These results suggest that visits to the obstetrics-gynecology clinic may be important, and currently missed, opportunities for cardiovascular disease prevention,” said Julie Schmittdiel, Ph.D, a research scientist with the Kaiser Permanente Division of research and the lead author of the study. “Since undiagnosed hypertension prior to age forty and the length of time of exposure to high blood pressures are known risk factors for cardiovascular mortality, further attention to elevated blood pressures in women under 50 by both providers in medicine and obstetrics-gynecology clinics may be an important approach.”
The researchers explain that technologies alone are not sufficient to assure guideline –driven care. “Ideally, integrated health care systems should be able to detect incident hypertension regardless of the type of clinic in which it presents and implement system-level outreach programs targeted at patients or their providers to address elevated blood pressures in young female patients without-pre-existing risk factors,” explained Schmittdiel.
This study was conducted within the Cardiovascular Research Network (CVRN), a consortium of research organizations affiliated with the HMO research network and sponsored by the National Heart Lung and Blood Institute. The study population consists of patients from the CVRN Hypertension Registry, a multi-site data source comprised of over 500,000 patients with hypertension. The study included women ages 18-49 with new onset hypertension between 2002 and 2006 whose hypertension was manifested through consecutive elevated blood pressure of systolic blood pressure great than or equal to 140mmHg or diastolic blood pressure greater than or equal to 90mmHg.
Additional authors on the study include Joe V. Selby, MPH; Bix Swain , MS; and Thomas K Leong, also with the Kaiser Permanente Division of Research; Stacie L Daugherty, MD, MSPH, with the University of Colorado, Denver; Michael Ho, MD, with the University of Colorado, Denver VA Medical Center; Karen L. Margolis, MD, MPH, and Patrick O’Connor, MD, MPH, with Health Partners in Minnesota; David J. Magid, MD, MPG, with the Institute for Health Research, Kaiser Permanente, Colorado; and Kirsten Bibbins-Domingo, MD, PhD, with the UCSF school of medicine.