Table 2.

Comprehensive codebook of scenarios of suboptimal clinician guideline adherence in the management of severe hypertension

Main Content Domain	Subcategory	Description
Clinician-related scenarios		Scenarios of non-initiation/non-intensification of antihypertensive treatment by the clinician due to issues relating to clinician intention, capability or scope.
	Neglect	Clinician did not acknowledge nor prioritize the BP at visit
	Diffusion of responsibility	Specialist visited did not initiate/intensify treatment, opting instead to defer responsibility to a hypertension-managing provider (i.e., PCP, cardiologist, etc.), excluding cases where an urgent referral to said provider was made.
Patient-related scenarios		Scenarios of non-initiation/non-intensification of antihypertensive treatment by the clinician due to patient behavioral considerations.
	Patient non-adherence	Clinician did not intensify intervention due to patient’s non-adherence to current therapy.
	Patient preference	Clinician did not initiate/intensify intervention due to patient preference not to.
Clinical complexity-related scenarios		Scenarios of non-initiation/non-intensification of antihypertensive treatment by the clinician due to clinical situational complexities.
	Diagnostic uncertainty with BP measurement	The clinician did not initiate or intensify treatment due to variations in BP measurements, whether at home or in the office. This includes cases where high in-office readings were believed to be a result of the white coat effect, pain, or other causes of reactive elevated BP.
	Maintenance of current BP intervention	Clinician chose to delay intensifying treatment in order to observe if current antihypertensives/lifestyle modifications would result in BP control.
	Competing medical priorities	Clinician did not intensify treatment due to competing clinical considerations

Abbreviation: BP: blood pressure; PCP: primary care provider.