Methods of defining hypertension in electronic medical records: validation against national survey data

J Public Health (Oxf). 2016 Sep;38(3):e392-e399. doi: 10.1093/pubmed/fdv155. Epub 2015 Nov 6.

Abstract

Background: Electronic medical records (EMR) can be a cost-effective source for hypertension surveillance. However, diagnosis of hypertension in EMR is commonly under-coded and warrants the needs to review blood pressure and antihypertensive drugs for hypertension case identification.

Methods: We included all the patients actively registered in The Health Improvement Network (THIN) database, UK, on 31 December 2011. Three case definitions using diagnosis code, antihypertensive drug prescriptions and abnormal blood pressure, respectively, were used to identify hypertension patients. We compared the prevalence and treatment rate of hypertension in THIN with results from Health Survey for England (HSE) in 2011.

Results: Compared with prevalence reported by HSE (29.7%), the use of diagnosis code alone (14.0%) underestimated hypertension prevalence. The use of any of the definitions (38.4%) or combination of antihypertensive drug prescriptions and abnormal blood pressure (38.4%) had higher prevalence than HSE. The use of diagnosis code or two abnormal blood pressure records with a 2-year period (31.1%) had similar prevalence and treatment rate of hypertension with HSE.

Conclusions: Different definitions should be used for different study purposes. The definition of 'diagnosis code or two abnormal blood pressure records with a 2-year period' could be used for hypertension surveillance in THIN.

Keywords: antihypertensive drug; blood pressure; diagnosis code; electronic medical records; hypertension.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Antihypertensive Agents / therapeutic use
  • Blood Pressure
  • Cross-Sectional Studies
  • Drug Prescriptions / statistics & numerical data
  • Electronic Health Records* / standards
  • Electronic Health Records* / statistics & numerical data
  • Female
  • Humans
  • Hypertension / diagnosis
  • Hypertension / drug therapy
  • Hypertension / epidemiology*
  • Male
  • Middle Aged
  • Prevalence
  • United Kingdom / epidemiology
  • Young Adult

Substances

  • Antihypertensive Agents

Grant support