High BP, No HTN Diagnosis More Likely in Young Adults Than Old--Why?

November 12, 2012

LOS ANGELES — Imagine two individuals, one age 21 and the other 61, who repeatedly show high blood pressure when seeing a doctor or other provider; the younger patient is far less likely than the older one to receive a diagnosis of hypertension, suggests an analysis of primary-care visits at a large academic group practice.

The likelihood of a hypertension diagnosis, the analysis further suggests, is significantly raised for younger patients who are African American or diabetic or whose provider is a woman. And it is significantly reduced for younger patients who don't speak English as their primary language, reported Dr Heather M Johnson (University of Wisconsin School of Medicine and Public Health, Madison). Johnson led the study that was based on >13 000 adult patients initially without hypertension but who qualified for a hypertension diagnosis when seen by providers over four years.

The analysis reveals that a variety of reasons, including "patient characteristics, provider factors, and healthcare-system issues," contribute to a missing hypertension diagnosis in younger patients who ought to receive one, she said for heartwire . So the findings could help "development of interventions within the healthcare system tailored to young adults, so that hopefully we can improve the diagnosis rates and improve hypertension control in this population."

Johnson formally presented the retrospective study based on 2008-2011 data last week here at the American Heart Association 2012 Scientific Sessions.

In adjusted analysis, the hazard ratio (HR) for receiving a deserved hypertension diagnosis was, compared with patients aged >60 years, 0.72 (95% CI 0.58–0.91, p=0.005) for those aged 18 to 24 and 0.74 (95% CI 0.63–0.86, p<0.001) for those aged 25 to 31.

"More young adults remained undiagnosed over time," Johnson said. "However, among [the 5942] adults who received a hypertension diagnosis, there was not a significant difference in the time to diagnosis. By age group, all of the adults received a hypertension diagnosis within six months."

13 593 Patients With BPs Meeting Definition for Hypertension by Age Group and Status of Hypertension Diagnosis

Age group (y) Total for age group (n) % undiagnosed after 4 ya Total receiving hypertension diagnosis (n) Months to hypertension diagnosisb
18–24 500 67.4 163 4.6
25–31 1203 65.0 421 5.1
32–39 1859 59.9 745 5.3
40–59 6768 54.0 3115 5.6
>60 3263 54.1 1498 6.0
All ages 13 593 56.3 5942 5.6

a. p<0.001 for trend by age group

b. p=0.082 for trend by age group

One pattern to emerge: younger patients belonging to some groups recognized to have a greater likelihood of hypertension, such as African Americans and diabetics, were more likely to receive a hypertension diagnosis. The same applied to those with the highest early blood-pressure readings or a greater number of provider visits and those with specialty-care providers. Of interest and unexplained, Johnson said, was that female providers were more likely than male ones to make the appropriate diagnosis.

That a deserved hypertension diagnosis in younger patients was less likely from family-practice providers was of borderline significance, "not enough to draw any conclusions from it," according to Johnson.

Independent Predictors of Initial Hypertension Diagnosis Among Adults Aged 18–39 Years

Predictor HR (95% CI) p
African American (vs white) 1.39 (1.09–1.78) 0.009
Current or second-hand tobacco exposure (vs never-used) 0.71 (0.58–0.87) 0.001
Diabetes (vs none) at baseline 1.51 (1.05–2.15) 0.025
Number of primary-care visits 1.14 (1.12–1.16) <0.001
Number of specialty-care visits 1.07 (1.05–1.10) <0.001
Family medicine/family practice (vs internal medicine) 0.84 (0.71–1.00) 0.047
Female provider (vs male) 1.23 (1.05–1.43) 0.009


The study was funded by the National Heart, Lung, and Blood Institute. Neither Johnson nor her coauthors had disclosures.