Quantifying risk of adverse clinical events with one set of vital signs among primary care patients with hypertension

William M. Tierney, Margaret Brunt, Joseph Kesterson, Xiao Hua Zhou, Gil L'Italien, Pablo Lapuerta

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

BACKGROUND: Hypertension is often uncontrolled. One reason might be physicians' reticence to modify therapy in response to single office measurements of vital signs. METHODS: Using electronic records from an inner-city primary care practice, we extracted information about vital signs, diagnoses, test results, and drug therapy available on the first primary care visit in 1993 for patients with hypertension. We then identified multivariable predictors of subsequent vascular complications in the ensuing 5 years. RESULTS: Of 5,825 patients (mean age 57 years) previously treated for hypertension for 5.6 years, 7% developed myocardial infarctions, 17% had strokes, 24% developed ischemic heart disease, 22% had heart failure, 12% developed renal insufficiency, and 13% died in 5 years. Controlling for other clinical data, a 10-mmHg increase in systolic blood pressure was associated with 13% increased risk (95% confidence interval [CI], 6%-21%) of renal insufficiency, 9% (95% CI, 3%-15%) increased risk of ischemic heart disease, 7% (95% CI, 3%-11%) increased risk of stroke, and 6% (95% CI, 2%-9%) increased risk of first stroke or myocardial infarction. A 10-mmHg elevation in mean blood pressure predicted a 12% (95% CI, 5%-20%) increased risk of heart failure. An increase in heart rate of 10 beats per minute predicted a 16% (95% CI, 2%-5%) increased risk of death. Diastolic blood pressure predicted only a 13% (95% CI, 4%-23%) increased risk of first stroke. CONCLUSIONS: Vital signs-especially systolic blood pressure-recorded routinely during a single primary care visit had significant prognostic value for multiple adverse clinical events among patients treated for hypertension and should not be ignored by clinicians.

Original languageEnglish
Pages (from-to)209-217
Number of pages9
JournalAnnals of Family Medicine
Volume2
Issue number3
DOIs
StatePublished - May 2004

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Vital Signs
Primary Health Care
Confidence Intervals
Blood Pressure
Hypertension
Stroke
Renal Insufficiency
Myocardial Ischemia
Heart Failure
Myocardial Infarction
Blood Vessels
Heart Rate
Physicians
Drug Therapy

Keywords

  • Blood pressure
  • Cardiovascular risk
  • Hypertension
  • Prognosis

ASJC Scopus subject areas

  • Family Practice

Cite this

Quantifying risk of adverse clinical events with one set of vital signs among primary care patients with hypertension. / Tierney, William M.; Brunt, Margaret; Kesterson, Joseph; Zhou, Xiao Hua; L'Italien, Gil; Lapuerta, Pablo.

In: Annals of Family Medicine, Vol. 2, No. 3, 05.2004, p. 209-217.

Research output: Contribution to journalArticle

Tierney, William M. ; Brunt, Margaret ; Kesterson, Joseph ; Zhou, Xiao Hua ; L'Italien, Gil ; Lapuerta, Pablo. / Quantifying risk of adverse clinical events with one set of vital signs among primary care patients with hypertension. In: Annals of Family Medicine. 2004 ; Vol. 2, No. 3. pp. 209-217.
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