Age- and sex-biased underdetection of hypertension in a rural clinic.

A process-of-care audit to assess completeness of hypertension detection among practice users was conducted by a rural family practice. For the two-year period 1983-1984, there were 5,620 practice users, ages 18-74. A cross-sectional study of the frequency of the diagnosis hypertension in these patients was carried out. Age-sex specific rates were calculated and compared to expected rates based on national prevalence estimates. Completeness of detection varied in direct proportion to age, from a low of 7% in the 18-24 group, to a high of 95% in the 65-74 group. For every age group women had a higher detection rate than men. The overall practice detection rate was 71%. Despite a practice emphasis on hypertension, detection appeared incomplete, especially among young men. Possible explanations are infrequent visits by young men, systematic error in blood pressure measurement, and definitional differences between primary care practice and national prevalence studies.