title: Missed opportunities in cardiovascular disease prevention?: low rates of hypertension recognition for women at medicine and obstetrics-gynecology clinics.
abstract: Younger women use both internal medicine and obstetrics-gynecology (OBGYN) clinics as primary sources of health care. However, the role of OBGYN clinics in cardiovascular disease prevention is largely unexplored. The objective of this study was to examine rates of hypertension recognition in women<50 years of age who presented with elevated blood pressures in family practice and internal medicine (medicine) OBGYN clinics and to compare these rates across clinic type. The study's population consisted of 34 627 nonpregnant women ages 18 to 49 years with new-onset hypertension (defined as 2 consecutive visits with elevated blood pressures of systolic blood pressure≥140 mm Hg or diastolic blood pressure≥90 mm Hg with no previous hypertension history) from 2002 to 2006. Multivariate logistic regressions predicting the clinical recognition of hypertension (a recorded diagnosis of hypertension and/or an antihypertensive prescription by any provider within 1 year of the second elevated blood pressure) assessed the association between hypertension recognition and the clinic where the second elevated blood pressure was recorded. Analysis showed that hypertension was recognized in <33% of women with new-onset hypertension. Women whose second consecutive elevated blood pressure was recorded in OBGYN clinics were less likely to be recognized as having hypertension within 12 months by any provider compared with women whose second consecutive elevated blood pressure was recorded in a medicine clinic (odds ratio: 0.51 [95% CI: 0.48 to 0.54]). This study suggests that further attention be paid to identifying and treating cardiovascular disease risk factors in women<50 years of age presenting in both medicine and OBGYN clinics and that improved coordination across care settings has the potential to improve cardiovascular disease prevention in young women.
authors.affiliation: Kaiser Permanente Northern California, Division of Research, 2000 Broadway, Oakland, CA 94612, USA. Julie.A.Schmittdiel@kp.org
authors.forename: Julie
authors.initials: J
authors.lastname: Schmittdiel
authors.forename: Joe V
authors.initials: JV
authors.lastname: Selby
authors.forename: Bix
authors.initials: B
authors.lastname: Swain
authors.forename: Stacie L
authors.initials: SL
authors.lastname: Daugherty
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Leong
authors.forename: Michael
authors.initials: M
authors.lastname: Ho
authors.forename: Karen L
authors.initials: KL
authors.lastname: Margolis
authors.forename: Patrick
authors.initials: P
authors.lastname: O'Connor
authors.forename: David J
authors.initials: DJ
authors.lastname: Magid
authors.forename: Kirsten
authors.initials: K
authors.lastname: Bibbins-Domingo
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities; D001795:Blood Pressure Determination; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D005260:Female; D006176:Gynecology; D006801:Humans; D006973:Hypertension / Q000175:diagnosis*; D016015:Logistic Models; D008875:Middle Aged; D009774:Obstetrics; D016017:Odds Ratio; D016387:Women's Health