Abstract 16557: Predictors of Undiagnosed Hypertension Among Young Adults with Regular Primary Care Use

Abstract

Background: Young adults have lower rates of hypertension (HTN) control (35%) compared to middle-aged and older adults (50%). We do not know the factors driving delays in diagnosing HTN in young adults who are regular users of primary care. The purpose of this study was to determine predictors of delays in the initial HTN diagnosis among young adults.

Methods: This was a retrospective analysis of 33,972 patients, ≥18 years, receiving primary care in a large, Midwestern, academic group practice from 2009 - 2010. Patients met JNC7 criteria for an initial HTN diagnosis. Patients with a previous HTN diagnosis or previous antihypertensive medication were excluded. Cox proportional hazard modeling (HR; 95% CI) was used to determine predictors that contribute to delays in a HTN diagnosis.

Results: After 2 years, 78% of adults 18-24 years meeting clinical criteria for HTN remained undiagnosed compared to 71% (25-31 years), 61% (32-39 years), 45% (40-59 years) and 32% (≥60 years), p<0.001. Adjusting for patient demographics, comorbidities, and provider factors, adults 18-24 years were 65% less likely to receive a diagnosis (HR 0.35; 0.29-0.42), compared to ≥60 years old, p<0.001. Adults 25-31 years (HR 0.39; 0.35-0.43), 32-39 years (HR 0.51; 0.47-0.55), and 40-59 years (HR 0.74; 0.72-0.77) also had a lower likelihood of a diagnosis, p<0.001. Young adults 18-24 years were 31% less likely (HR 0.69; 0.56-0.85) to receive a diagnosis compared to 32-39 years. Young adults with depression, hypothyroidism, lung disease, higher healthcare utilization scores, higher urgent care use, and a non-English primary language were less likely to be diagnosed. Young adults with ethnic minority status, higher weight, dyslipidemia, chronic kidney disease, more primary care visits, and a female provider were more likely to receive a diagnosis. Pediatricians and specialty providers were more likely to diagnose HTN in young adults compared to Internal Medicine, Family Practice, and OB/Gyn providers.

Conclusions: After 2 years with regular primary care use, the majority of young adults with HTN remained undiagnosed. Provider, patient, and healthcare system factors are all critical determinants of poor HTN diagnosis rates among young adults.