--- title: "Under diagnosis of hypertension using electronic health records. | Sutter Health" description: "We sought to identify prevalent and incident hypertension cases, diagnosis rates in an outpatient system, and identify factors associated with the diagnosis." url: "https://www.sutterhealth.org/research/publications/under-diagnosis-of-hypertension-using-ehr-1055312667" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. Under diagnosis of hypertension using electronic health records. # Under diagnosis of hypertension using electronic health records. Banerjee D, Chung S, Wong EC, Wang EJ, Stafford RS, & Palaniappan LP. _Am J Manag Care. 16(2):e35-42_ 2010-02-01 ## Abstract ****Background:**** Hypertension is highly prevalent and contributes to cardiovascular morbidity and mortality. Appropriate identification of hypertension is fundamental for its management. The rates of appropriate hypertension diagnosis in outpatient settings using an electronic health record (EHR) have not been well studied. We sought to identify prevalent and incident hypertension cases in a large outpatient healthcare system, examine the diagnosis rates of prevalent and incident hypertension, and identify clinical and demographic factors associated with appropriate hypertension diagnosis. ****Methods:**** We analyzed a 3-year, cross-sectional sample of 251,590 patients aged ≥18 years using patient EHRs. Underlying hypertension was defined as two or more abnormal blood pressure (ABP) readings ≥140/90 mm Hg and/or pharmaceutical treatment. Appropriate hypertension diagnosis was defined by the reporting of ICD-9 codes (401.0–401.9). Factors associated with hypertension diagnosis were assessed through multivariate analyses of patient clinical and demographic characteristics. ****Results:**** The prevalence of hypertension was 28.7%, and the diagnosis rate was 62.9%. The incidence of hypertension was 13.3%, with a diagnosis rate of 19.9%. Predictors of diagnosis for prevalent hypertension included older age, Asian, African American, higher body mass index (BMI), and increased number of ABP readings. Predictors for incident hypertension diagnosis were similar. In patients with two or more ABP readings, hypertension diagnosis was associated with significantly higher medication treatment rates (92.6% vs. 15.8%, __P__ < 0.0001). ****Conclusions:**** Outpatient EHR diagnosis rates are suboptimal, yet EHR diagnosis of hypertension is strongly associated with treatment. Targeted efforts to improve diagnosis should be a priority. [PubMed abstract](http://ajh.oxfordjournals.org/content/25/1/97.short) ## Research topics - [Cardiovascular Diseases](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Cardiovascular+Diseases%5C%22%22) - [Medical Informatics](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Medical+Informatics%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [Machine learning and atherosclerotic cardiovascular disease risk prediction in a multi-ethnic population.](https://www.sutterhealth.org/research/publications/asvd-risk-prediction-in-multi-ethnic-population-1055312841) Ward A, Sarraju A, Chung S, Li J, Harrington R, Heidenreich P, Palaniappan L, Scheinker D, Rodriguez F. 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Transl Behav Med. 1(1):123-33. doi: 10.1007/s13142-011-0023-5. 2011 Mar 01 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/under-diagnosis-of-hypertension-using-ehr-1055312667#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"Under diagnosis of hypertension using electronic health records."}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/under-diagnosis-of-hypertension-using-ehr-1055312667#medicalscholarlyarticle","name":"Under diagnosis of hypertension using electronic health records.","headline":"Under diagnosis of hypertension using electronic health records.","abstract":"Background: Hypertension is highly prevalent and contributes to cardiovascular morbidity and mortality. Appropriate identification of hypertension is fundamental for its management. The rates of appropriate hypertension diagnosis in outpatient settings using an electronic health record (EHR) have not been well studied. We sought to identify prevalent and incident hypertension cases in a large outpatient healthcare system, examine the diagnosis rates of prevalent and incident hypertension, and identify clinical and demographic factors associated with appropriate hypertension diagnosis. Methods: We analyzed a 3-year, cross-sectional sample of 251,590 patients aged ≥18 years using patient EHRs. Underlying hypertension was defined as two or more abnormal blood pressure (ABP) readings ≥140/90 mm Hg and/or pharmaceutical treatment. Appropriate hypertension diagnosis was defined by the reporting of ICD-9 codes (401.0–401.9). Factors associated with hypertension diagnosis were assessed through multivariate analyses of patient clinical and demographic characteristics. Results: The prevalence of hypertension was 28.7%, and the diagnosis rate was 62.9%. The incidence of hypertension was 13.3%, with a diagnosis rate of 19.9%. Predictors of diagnosis for prevalent hypertension included older age, Asian, African American, higher body mass index (BMI), and increased number of ABP readings. Predictors for incident hypertension diagnosis were similar. In patients with two or more ABP readings, hypertension diagnosis was associated with significantly higher medication treatment rates (92.6% vs. 15.8%, P \u003c 0.0001). Conclusions: Outpatient EHR diagnosis rates are suboptimal, yet EHR diagnosis of hypertension is strongly associated with treatment. Targeted efforts to improve diagnosis should be a priority.","description":"We sought to identify prevalent and incident hypertension cases, diagnosis rates in an outpatient system, and identify factors associated with the diagnosis.","keywords":["Cardiovascular Diseases","Medical Informatics"],"datePublished":"2010-02-01","url":"https://www.sutterhealth.org/research/publications/under-diagnosis-of-hypertension-using-ehr-1055312667","inLanguage":"en-US","isPartOf":{"@type":"Periodical","name":"Am J Manag Care"},"author":[{"@type":"Person","name":"Banerjee D"},{"@type":"Person","name":"Chung S"},{"@type":"Person","name":"Wong EC"},{"@type":"Person","name":"Wang EJ"},{"@type":"Person","name":"Stafford RS"},{"@type":"Person","name":"Palaniappan LP"}],"sourceOrganization":{"@type":"MedicalOrganization","name":"Palo Alto Medical Foundation Research Institute"},"about":[{"@type":"DefinedTerm","name":"Cardiovascular Diseases","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Cardiovascular+Diseases%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Medical Informatics","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Medical+Informatics%22%5D%7D%5D&verticalKey=research_publication"}],"mainEntityOfPage":{"@type":"WebPage","@id":"https://www.sutterhealth.org/research/publications/under-diagnosis-of-hypertension-using-ehr-1055312667","breadcrumb":{"@id":"https://www.sutterhealth.org/research/publications/under-diagnosis-of-hypertension-using-ehr-1055312667#breadcrumblist"}}} ```