ORIGINAL
PAPER
Differential Diagnosis and Treatment Rates Between Systolic and Diastolic Hypertension in Young Adults: A Multidisciplinary Observational Study Heather M. Johnson, MD, MS;1,2 Christie M. Bartels, MD, MS;1,2 Carolyn T. Thorpe, PhD, MPH;3 Jessica R. Schumacher, MS, PhD;2,4 Nancy Pandhi, MD, MPH;2,5 Maureen A. Smith, MD, PhD, MPH2,4,5,6 From the Department of Medicine, University of Wisconsin School of Medicine and Public Health;1 Health Innovation Program, University of Wisconsin School of Medicine and Public Health, Madison, WI;2 Health Services Research and Development, Veterans Affairs Pittsburgh Healthcare System and Department of Pharmacy & Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA;3 Department of Surgery, University of Wisconsin School of Medicine and Public Health;4 Department of Family Medicine, University of Wisconsin School of Medicine and Public Health;5 and Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI6
Differential rates of diagnosis and treatment by hypertension (HTN) type may contribute to poor HTN control in young adults. The objective of this study was to compare rates of receiving a hypertension diagnosis and antihypertensive agent among young adults with (1) isolated systolic, (2) isolated diastolic, and (3) combined systolic/diastolic HTN. A retrospective analysis was conducted in patients aged 18 to 39 years (n=3003) with incident HTN. Kaplan–Meier survival and Cox proportional hazards analyses were performed. Only 56% with isolated systolic HTN received a diagnosis compared with 63% (systolic/diastolic); 32% with isolated systolic HTN received an initial antihypertensive compared
with 52% (systolic/diastolic). Compared with patients with systolic/diastolic HTN, those with isolated systolic HTN had a 50% slower diagnosis rate (hazard ratio [HR], 0.50; 95% confidence interval [CI], 0.41–0.60) and those with isolated diastolic HTN had a 26% slower rate (HR, 0.74; CI, 0.60–0.92). Patients with isolated systolic HTN had 58% slower medication initiation (HR, 0.42; CI, 0.34–0.51) and those with isolated diastolic HTN had 31% slower rates (HR, 0.69; CI, 0.55–0.86). Young adults with isolated systolic HTN have lower diagnosis and treatment rates. J Clin Hypertens (Greenwich). 2015;17:885–894. ª 2015 Wiley Periodicals, Inc.
Hypertension (HTN) remains an underrecognized cardiovascular risk factor among young adults (aged 18 to 39 years).1 Uncontrolled HTN in young adults contributes to premature target organ damage and an increased risk of cardiovascular morbidity and mortality.2–4 Unfortunately, young adults with HTN in the United States have the lowest awareness, treatment, and control rates compared with middle-aged and older adults.1 Sociodemographic factors and comorbid conditions that contribute to poor diagnosis and treatment rates in this population have been previously identified.5 It is unclear whether the type of HTN (eg, isolated systolic, isolated diastolic, combined systolic/diastolic)6,7 also contributes to low rates of diagnosis and treatment among young adults. According to the National Health and Nutrition Examination Survey (NHANES), isolated diastolic HTN is the most common HTN subtype among untreated young adults (
PAPER
Differential Diagnosis and Treatment Rates Between Systolic and Diastolic Hypertension in Young Adults: A Multidisciplinary Observational Study Heather M. Johnson, MD, MS;1,2 Christie M. Bartels, MD, MS;1,2 Carolyn T. Thorpe, PhD, MPH;3 Jessica R. Schumacher, MS, PhD;2,4 Nancy Pandhi, MD, MPH;2,5 Maureen A. Smith, MD, PhD, MPH2,4,5,6 From the Department of Medicine, University of Wisconsin School of Medicine and Public Health;1 Health Innovation Program, University of Wisconsin School of Medicine and Public Health, Madison, WI;2 Health Services Research and Development, Veterans Affairs Pittsburgh Healthcare System and Department of Pharmacy & Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA;3 Department of Surgery, University of Wisconsin School of Medicine and Public Health;4 Department of Family Medicine, University of Wisconsin School of Medicine and Public Health;5 and Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI6
Differential rates of diagnosis and treatment by hypertension (HTN) type may contribute to poor HTN control in young adults. The objective of this study was to compare rates of receiving a hypertension diagnosis and antihypertensive agent among young adults with (1) isolated systolic, (2) isolated diastolic, and (3) combined systolic/diastolic HTN. A retrospective analysis was conducted in patients aged 18 to 39 years (n=3003) with incident HTN. Kaplan–Meier survival and Cox proportional hazards analyses were performed. Only 56% with isolated systolic HTN received a diagnosis compared with 63% (systolic/diastolic); 32% with isolated systolic HTN received an initial antihypertensive compared
with 52% (systolic/diastolic). Compared with patients with systolic/diastolic HTN, those with isolated systolic HTN had a 50% slower diagnosis rate (hazard ratio [HR], 0.50; 95% confidence interval [CI], 0.41–0.60) and those with isolated diastolic HTN had a 26% slower rate (HR, 0.74; CI, 0.60–0.92). Patients with isolated systolic HTN had 58% slower medication initiation (HR, 0.42; CI, 0.34–0.51) and those with isolated diastolic HTN had 31% slower rates (HR, 0.69; CI, 0.55–0.86). Young adults with isolated systolic HTN have lower diagnosis and treatment rates. J Clin Hypertens (Greenwich). 2015;17:885–894. ª 2015 Wiley Periodicals, Inc.
Hypertension (HTN) remains an underrecognized cardiovascular risk factor among young adults (aged 18 to 39 years).1 Uncontrolled HTN in young adults contributes to premature target organ damage and an increased risk of cardiovascular morbidity and mortality.2–4 Unfortunately, young adults with HTN in the United States have the lowest awareness, treatment, and control rates compared with middle-aged and older adults.1 Sociodemographic factors and comorbid conditions that contribute to poor diagnosis and treatment rates in this population have been previously identified.5 It is unclear whether the type of HTN (eg, isolated systolic, isolated diastolic, combined systolic/diastolic)6,7 also contributes to low rates of diagnosis and treatment among young adults. According to the National Health and Nutrition Examination Survey (NHANES), isolated diastolic HTN is the most common HTN subtype among untreated young adults (
