Abstract
Objective: We aimed to characterize seasonal variation in US population-based blood pressure (BP) control and BP-related metrics and evaluate the association between outdoor temperature and BP control variation. Methods: We queried electronic health records (EHRs) from 26 health systems, representing 21 states, to summarize BP metrics by quarters of 12-month periods from January 2017 to March 2020. Patients with at least one ambulatory visit during the measurement period and a hypertension diagnosis during the first 6 months or prior to the measurement period were included. Changes in BP control, BP improvement, medication intensification, average SBP reduction after medication intensification across quarters and association with outdoor temperature were analyzed using weighted generalized linear models with repeated measures. Results: Among 1 818 041 people with hypertension, the majority were more than 65 years of age (52.2%), female (52.1%), white non-Hispanic (69.8%) and had stage 1/2 hypertension (64.8%). Overall, BP control and process metrics were highest in quarters 2 and 3, and lowest in quarters 1 and 4. Quarter 2 had the highest percentage of improved BP (31.95 ± 0.90%) and average SBP reduction after medication intensification (16 ± 0.23 mmHg). Quarter 3 had the highest percentage of BP controlled (62.25 ± 2.55%) and lowest with medication intensification (9.73 ± 0.60%). Results were largely consistent in adjusted models. Average temperature was associated with BP control metrics in unadjusted models, but associations were attenuated following adjustment. Conclusion: In this large, national, EHR-based study, BP control and BP-related process metrics improved during spring/summer months, but outdoor temperature was not associated with performance following adjustment for potential confounders.
Original language | English (US) |
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Pages (from-to) | 751-758 |
Number of pages | 8 |
Journal | Journal of hypertension |
Volume | 41 |
Issue number | 5 |
DOIs | |
State | Published - May 1 2023 |
Funding
This work was conducted with the Accelerating Data Value Across a National Community Health Center Network (ADVANCE) Clinical Research Network (CRN). ADVANCE is a CRN in PCORnet, the National Patient Centered Outcomes Research Network. ADVANCE is led by OCHIN in partnership with Health Choice Network, Fenway Health, [and] Oregon Health & Science University, [and the Robert Graham Center HealthLandscape]. ADVANCE's participation in PCORnet is funded through the Patient-Centered Outcomes Research Institute (PCORI), contract number RI-OCHIN-01-MC. XiaoXia Champon was funded by the T32 NIH grant number HL079896. None of the other authors have anything to report. This study was supported by a partnership including the Patient-Centered Outcomes Research Institute (PCORI contract PaCR-2017C2-8153), the American Medical Association (funding and in-kind support) and the American Heart Association (in-kind support). The American Medical Association and the American Heart Association are represented on the steering committee. The findings and conclusions are those of the authors and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute, the American Medical Association or the American Heart Association.
Keywords
- blood pressure control
- electronic health record
- hypertension
- seasonal variation
ASJC Scopus subject areas
- Internal Medicine
- Physiology
- Cardiology and Cardiovascular Medicine