Flipping the Visit: Impact of Blood Pressure Remeasurement after the Visit

Excerpt

Hypertension is one of the most common conditions managed in primary care and is a major risk factor for cardiovascular morbidity and mortality. With the release of the 2017 ACC/AHA hypertension guidelines with new thresholds for diagnosis, the age-standardized prevalence of hypertension increased from 29% (JNC7 guidelines) to 45.5% in 2015–2016.^{1, 2} While hypertension remains one of the most impactful conditions primary care physicians manage, overtreatment can adversely affect patients. In a cohort of over 300,000 elderly patients newly treated for hypertension, there was a 43% increased risk of hip fracture occurring within 45 days following treatment initiation.³ In addition, low daytime systolic BP (< 128 mmHg) has been shown to be independently associated with greater progression of cognitive decline in a cohort of elderly patients with baseline cognitive impairment.⁴ Accurate assessment of BP is imperative to avoid overtreatment, especially in the elderly population. It is well known that many factors affect BP measurement, including talking, smoking, mental stress, and measurement in the inappropriate position and over clothing.⁵ Many of these factors exist just prior to an office visit and can be eliminated if the BP is assessed following the visit. We undertook this quality improvement initiative to determine the impact of BP reassessment after a clinic visit in a select population of male veterans. …