To the Editor
Prehypertension is extremely common. In primary care clinics, as many as 40% of adults who do not have hypertension have prehypertension.1 We recently reported that there appeared to be neither harmful nor helpful effects of labeling patients as prehypertensive.2 Whether clinicians are actually using the term “prehypertension” with patients has not been specifically examined to our knowledge, although our recent paper suggests that very few patients with prehypertension are told about it.2 The purpose of this study was to estimate how often patients with prehypertension are told about it.
Methods
We conducted a cross-sectional study of patients visiting seven primary care practices within the North Carolina Family Medicine Research Network (NC-FM-RN).3 In summer 2008, research assistants offered participation to all adult English and Spanish-speaking patients in waiting rooms of these seven practices across NC during a 3-week period. In addition to demographic and other health questions, participants were asked to indicate whether a doctor or other health care provider had told them they had “high blood pressure or hypertension” (Yes/No), “prehypertension” (Yes/No), or “borderline hypertension” (Yes/No). In order to estimate the prehypertension “eligible” population, we used an independently validated automatic oscillometric monitor with a cuff that accommodates both standard and large adult arms4 to measure blood pressures of a subsample of participants while in the waiting rooms. This study was approved by the Institutional Review Board of the University of North Carolina at Chapel Hill School of Medicine.
Results
Of 1754 patients completing the survey (overall response rate 63.9%), 42.5% indicated a history of hypertension. Among those not indicating a history of hypertension (n=1008), 4.3% indicated being told of borderline hypertension, and 1.9% indicated being told of prehypertension (Table). Less than 1% indicated both. Of a subsample of 182 patients without known hypertension who had BP measured as part of this study, 102 had BP in the prehypertension range. Among this group, 2.0% of patients indicated being told they have prehypertension and 3.9% indicated being told that their BP was borderline (Table).
Table. Percentage of Non-hypertensive Adult Patients Reporting being Told about Prehypertension or Borderline Hypertension.
| All non-hypertensive adults in sample (n=1008) | Non-hypertensive adults with measured BP in the prehypertension range (n=102) | |||
|---|---|---|---|---|
|
| ||||
| Percent | 95% confidence interval | Percent | 95% confidence interval | |
| Prehypertension | 1.9 | 1.0 – 2.7 | 2.0 | -0.8 – 4.7 |
| Borderline hypertension | 4.3 | 3.0 – 5.5 | 3.9 | 1.0 – 7.8 |
Comments
Few patients who probably have prehypertension recall being told about it. It is possible that patients were told about prehypertension and just do not recall it, but we think it more likely that clinicians do not use this term with patients. The term “borderline” might be preferred by clinicians, but we found that recollection of being told about borderline hypertension was only slightly more common. One possible explanation for not engaging patients in a discussion about prehypertension is that clinicians do not find it useful in practice. It is possible that clinicians counsel patients about lifestyle modifications that will reduce their chances of developing hypertension without telling them specifically about prehypertension.
Acknowledgments
The authors thank Katharine Butler, Dax Varkey, Shannon Skinner, and Jessica Taylor who also helped administer the surveys and collect data.
Footnotes
Financial Disclosures: Funding was provided in part by a grant from NIDDK grant # T35 DK07386 at the University of North Carolina at Chapel Hill School of Medicine. Data collection and analysis for this project was funded by NIH grant # K07 AG21587. Dr. Viera's time was funded by NIH/NCRR grant # 1KL2RR025746-01.
Publisher's Disclaimer: Disclaimer: We have no conflicts of interest to declare.
Contributor Information
Anthony J. Viera, Department of Family Medicine, University of North Carolina at Chapel Hill School of Medicine.
Fatima Bangura, University of North Carolina at Chapel Hill School of Medicine.
C. Madeline Mitchell, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill.
Ana Cerna, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill.
Philip Sloane, Department of Family Medicine, University of North Carolina at Chapel Hill School of Medicine and the Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill.
References
- 1.Viera AJ. The new “normal” blood pressure: what are the implications for family medicine? J Am Board Fam Med. 2007;20(1):45–51. doi: 10.3122/jabfm.2007.01.060088. [DOI] [PubMed] [Google Scholar]
- 2.Viera AJ, Lingley K, Esserman D. The effects of labeling patients as prehypertensive. J Am Bard Fam Med. 2010;23:571–583. doi: 10.3122/jabfm.2010.05.100047. [DOI] [PubMed] [Google Scholar]
- 3.Sloane PD, Callahan L, Kahwati L, Mitchell CM. Development of a practice-based patient cohort for primary care research. Fam Med. 2006;38:50–57. [PubMed] [Google Scholar]
- 4.Viera AJ, Hinderliter AL. Validation of the HEM-780REL with easy wrap cuff for self-measurement of blood pressure according to the European Society of Hypertension International Protocol. Blood Press Monit. 2007;12(5):335–8. doi: 10.1097/MBP.0b013e3281404a7e. [DOI] [PubMed] [Google Scholar]