Increasing Pressure to Lower Blood Pressure: Assessing Blood Pressure Goals at Resident Physician Clinic

Introduction: The 2017 ACC/AHA guidelines lowered the threshold for blood pressure goals and emphasized incorporation of cardiovascular risk assessment and lifestyle modifications. Due to this update, the prevalence of hypertension increased from 31.9% to 45.6% of Americans. We hypothesized that our patients were not being assessed and counseled in accordance with the 2017 ACC/AHA guidelines at our resident clinic in New York City. Methods: Patients with a diagnosis of hypertension who had at least one office visit between July to September of 2018 at our clinic were included. Patients not seen by a resident physician were excluded. Variables collected included lowest blood pressure reading from visit, comorbidities, and demographics (age, language, race, and gender). The most recent progress note was reviewed for the assessment of hypertension. Additionally, residents of all levels completed an electronic anonymous survey to assess knowledge of updated guidelines. Results: Of the 206 patients meeting inclusion and not exclusion criteria, 148 (71.8%) were above blood pressure goal. The average blood pressure was 137/82 (CI 95%, 134.7-139.3/80.6-83.4). Of those 148 patients not at goal, 108 (72.97%) were incorrectly identified as at goal or did not have hypertension assessed at all. Of the total 206 patients, only 16 (7.77%) had documented discussion of lifestyle modification and 1 patient (0.5%) had an atherosclerotic cardiovascular disease (ASCVD) score in the assessment. Patients with an established resident primary care physician (n=118) were not more likely to meet goal blood pressure (p=0.58) than those who did not. A total of 27 of 78 (34.6%) residents completed the survey, and only 15% (4 of 27) answered all questions correctly. Conclusions: Our hypertensive patients are not meeting their blood pressure goals and often the assessment is insufficient. We are not reliably identifying patients with elevated blood pressure per the 2017 ACC/AHA guidelines and missing opportunities for optimizing care. Enhancing resident understanding of guidelines and evaluation of hypertension is important for meeting blood pressure targets and reducing cardiovascular risk. An intervention to improve resident education and documentation is underway.