Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, Florida.
Department of Community Health and Family Medicine, College of Medicine, University of Florida, Gainesville, Florida.
Prev Chronic Dis. 2018 Mar 1;15:E27. doi: 10.5888/pcd15.170332.
Hypertension is highly prevalent in Florida, but surveillance through the Behavioral Risk Factor Surveillance System (BRFSS) is limited to self-reported hypertension and does not capture data on undiagnosed hypertension or measure blood pressure. We aimed to characterize the hypertensive population in the OneFlorida Clinical Research Consortium by using electronic health records and provide proof-of-concept for using routinely collected clinical data to augment surveillance efforts.
We identified patients with hypertension, defined as having at least 1 outpatient visit from January 2012 through June 2016 with an ICD-9-CM or ICD-10-CM diagnosis code for hypertension, or in the absence of a diagnosis, an elevated blood pressure (systolic ≥140 mm Hg or diastolic ≥90 mm Hg) recorded in the electronic health record at the most recent visit. The hypertensive population was characterized and mapped by zip code of patient residence to county prevalence.
Of 838,469 patients (27.9% prevalence) who met the criteria for hypertension, 68% had received a diagnosis and 61% had elevated blood pressure. The geographic distribution of hypertension differed between diagnosed hypertension (highest prevalence in northern Florida) and undiagnosed hypertension (highest prevalence along eastern coast, in southern Florida, and in some rural western Panhandle counties). Uncontrolled hypertension was concentrated in southern Florida and the western Panhandle.
Our use of clinical data, representing usual care for Floridians, allows for identifying cases of uncontrolled hypertension and potentially undiagnosed cases, which are not captured by existing surveillance methods. Large-scale pragmatic research networks, like OneFlorida, may be increasingly important for tailoring future health care services, trials, and public health programs.
高血压在佛罗里达州的发病率很高，但通过行为风险因素监测系统（BRFSS）进行监测仅限于自我报告的高血压，并且无法捕捉未确诊高血压的数据或测量血压。我们旨在通过电子健康记录来描述 OneFlorida 临床研究联盟中的高血压人群，并提供使用常规收集的临床数据来增强监测工作的概念验证。
我们确定了高血压患者，其定义为在 2012 年 1 月至 2016 年 6 月期间至少有 1 次门诊就诊，有 ICD-9-CM 或 ICD-10-CM 高血压诊断代码，或者在没有诊断的情况下，电子健康记录中最近一次就诊时记录的血压升高（收缩压≥140mmHg 或舒张压≥90mmHg）。根据患者居住地的邮政编码对高血压人群进行特征描述和绘制，以确定县患病率。
在符合高血压标准的 838469 名患者中（患病率为 27.9%），68%的患者接受了诊断，61%的患者血压升高。诊断高血压（佛罗里达州北部患病率最高）和未诊断高血压（佛罗里达州东海岸、南部和一些西部狭长地带的农村县患病率最高）的地理分布不同。未控制的高血压主要集中在佛罗里达州南部和西部狭长地带。
我们使用的临床数据代表了佛罗里达人的常规护理，这使得我们能够识别出未被现有监测方法捕捉到的未控制高血压和潜在未确诊病例。像 OneFlorida 这样的大型实用研究网络对于未来医疗服务、试验和公共卫生计划的调整可能越来越重要。
