title: Undiagnosed hypertension among young adults with regular primary care use.
abstract: OBJECTIVE
  Young adults meeting hypertension diagnostic criteria have a lower prevalence of a hypertension diagnosis than middle-aged and older adults. The purpose of this study was to compare the rates of a new hypertension diagnosis for different age groups and identify predictors of delays in the initial diagnosis among young adults who regularly use primary care.
  
  
  METHODS
  A 4-year retrospective analysis included 14 970 patients, at least 18 years old, who met clinical criteria for an initial hypertension diagnosis in a large, Midwestern, academic practice from 2008 to 2011. Patients with a previous hypertension diagnosis or prior antihypertensive medication prescription were excluded. The probability of diagnosis at specific time points was estimated by Kaplan-Meier analysis. Cox proportional hazard models (hazard ratio; 95% confidence interval) were fit to identify predictors of delays to an initial diagnosis, with a subsequent subset analysis for young adults (18-39 years old).
  
  
  RESULTS
  After 4 years, 56% of 18-24-year-olds received a diagnosis compared with 62% (25-31-year-olds), 68% (32-39-year-olds), and more than 70% (≥40-year-olds). After adjustment, 18-31-year-olds had a 33% slower rate of receiving a diagnosis (18-24 years hazard ratio 0.66, 0.53-0.83; 25-31 years hazard ratio 0.68, 0.58-0.79) compared with adults at least 60 years. Other predictors of a slower diagnosis rate among young adults were current tobacco use, white ethnicity, and non-English primary language. Young adults with diabetes, higher blood pressures, or a female provider had a faster diagnosis rate.
  
  
  CONCLUSIONS
  Provider and patient factors are critical determinants of poor hypertension diagnosis rates among young adults with regular primary care use.
authors.affiliation: aDepartment of Medicine bHealth Innovation Program, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin cHealth Services Research and Development, Veterans Affairs Pittsburgh Healthcare System and Department of Pharmacy & Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania dDepartment of Population Health Sciences eDepartment of Biostatistics and Medical Informatics fDepartment of Family Medicine gDepartment of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
authors.forename: Heather M
authors.initials: HM
authors.lastname: Johnson
authors.forename: Carolyn T
authors.initials: CT
authors.lastname: Thorpe
authors.forename: Christie M
authors.initials: CM
authors.lastname: Bartels
authors.forename: Jessica R
authors.initials: JR
authors.lastname: Schumacher
authors.forename: Mari
authors.initials: M
authors.lastname: Palta
authors.forename: Nancy
authors.initials: N
authors.lastname: Pandhi
authors.forename: Ann M
authors.initials: AM
authors.lastname: Sheehy
authors.forename: Maureen A
authors.initials: MA
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D000328:Adult; D003376:Counseling; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis*; D033162:Incidental Findings; D008019:Life Style; D008297:Male; D010353:Patient Education as Topic; D012189:Retrospective Studies; D055815:Young Adult