Delayed diagnosis of hypertension in diabetic patients monitored in primary care.
OBJECTIVE
Delayed diagnosis of hypertension may result in inadequate blood pressure control and increased cardiovascular risk. The aim of this study was to estimate the delay in hypertension diagnosis in patients with type 2 diabetes and the likelihood of a diagnosis within a suitable period (first 6 months), and to analyze the patient and physician characteristics associated with delayed diagnosis.


METHODS
Retrospective dynamic cohort study, with a 7-year follow-up in primary care, of 8074 adult patients with diabetes who met the diagnostic criteria for hypertension. Two thresholds were considered: 140/90mmHg and 130/80mmHg. The time elapsed between meeting these criteria and recording the diagnosis was estimated; the time course of the likelihood of a missed diagnosis and the variables associated with correct diagnosis were assessed by Kaplan-Meier survival analysis and logistic regression analysis, respectively.


RESULTS
The mean diagnostic delay was 8.9 (15.4) months in patients with blood pressure≥140/90mmHg compared to 15.2 (19.6) months for those with <140/90mmHg (P<.001). The main variables associated with correct diagnosis were baseline blood pressure≥140/90mmHg (odds ratio=2.77; 95% confidence interval, 2.44-3.15), no history of acute myocardial infarction (odds ratio=2.23; 95% confidence interval, 1.67-2.99), obesity (odds ratio=1.70; 95% confidence interval, 1.44-1.99), absence of depression (odds ratio=1.63; 95% confidence interval, 1.27-2.08), female sex (odds ratio=1.29; 95% confidence interval, 1.14-1.46), older age, and taking more intensive antidiabetic therapy. There was an inverse relationship with the age of physicians and a direct relationship with their professional stability.


CONCLUSIONS
The mean diagnostic delay in hypertension among diabetic patients was greater than 6 months and varied according to the diagnostic threshold used. Patients with baseline blood pressure≥140/90mmHg were more likely to receive a timely diagnosis.
Unidad de Epidemiología Clínica e Investigación, Hospital Carlos III, Servicio Madrileño de Salud, Madrid, Spain. Electronic address: carmenblunar@hotmail.com.
Carmen
C
de Burgos-Lunar
Unidad de Apoyo a la Investigación, Gerencia de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain; Departamento de Medicina Preventiva y Salud Pública, Universidad Rey Juan Carlos, Madrid, Spain.
Isabel
I
del Cura-González
Fundación de Investigación Biomédica, Hospital Carlos III, Servicio Madrileño de Salud, Madrid, Spain.
Miguel A
MA
Salinero-Fort
Fundación de Investigación Biomédica, Hospital Carlos III, Servicio Madrileño de Salud, Madrid, Spain.
Paloma
P
Gómez-Campelo
Unidad de Imagen Cardiovascular, Hospital Clínico San Carlos, Servicio Madrileño de Salud, Madrid, Spain.
Leopoldo
L
Pérez de Isla
Departamento de Medicina Preventiva y Salud Pública, Universidad Rey Juan Carlos, Madrid, Spain.
Rodrigo
R
Jiménez-García
D000368:Aged; D057210:Delayed Diagnosis / Q000706:statistics & numerical data; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D058065:Diabetic Cardiomyopathies / Q000175:diagnosis*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011320:Primary Health Care; D012189:Retrospective Studies
Atención primaria; BP; DM2; Delayed diagnosis; Diabetes mellitus; EMR; HT; Hipertensión arterial; Hypertension; PC; Primary care; Retraso diagnóstico; blood pressure; electronic medical record; hypertension; primary care; type 2 diabetes mellitus