Abstract 2111: Continuous Improvement in Returning Hypertensives to Normal - a Large 5 Year VA Analysis Displaying the Effect of Seasonal Variation
Background: The VA measures “Hypertensives Returning to Normal” (HRN) as a performance measure (PM) intending to improve hypertension system wide. A Health Data Repository, contains > 1.8 billion vitals (as of 10/06), aggregated from the Electronic Health Record (EHR) in use at all VA facilities. BP from 15 VA hospitals (Anchorage AL, Baltimore MD, Boston MS, Chicago IL, Fargo ND, Honolulu HI, Houston TX, West LA CA, Miami FL, Minneapolis MN, New York NY, Philadelphia PA, San Juan PR, Portland OR, and Washington DC) included 1,192,781 patients with 19,203,113 BP records.
Methods: Hypertensive patients were defined as those whose lowest BP on each of 3 separate days was >140 Systolic or >90 Diastolic. The latest BP was normal if ≤140 and ≤90 and was calculated at monthly intervals. Seasonal variation is defined as the difference in % HRN in winter and summer months (“A” in figure⇓).
Results: There were 443,632 patients who were hypertensive. These patients were analyzed for HRN. In each of 15 cities the HRN increased an average of 3.91 ± 0.72% per year (p <.0001) over 5 years. All had a HRN worse in winter than summer (average difference was 7.76 ± 0.94%, p<.0001).
Conclusions: With PM and the EHR, the number of hypertensive patients who return to normal was continuously increased an average of 3.9% per year over 5 years. In all cities fewer hypertensives return to normal in winter than in summer, but this seasonal effect is larger in some cities. Hypertension patients may require increased anti-hypertensive intervention during the winter months.