Hellgren Mikko, Boström Kristina Bengtsson, Hedin Katarina, Jansson Stefan, Nilsson Staffan, Nilsson Gunnar, Wändell Per, Wennberg Patrik
University Health Care Research Centre, Örebro University Hospital, Örebro, Sweden.
School of Medical Sciences, Örebro University, Örebro, Sweden.
J Clin Hypertens (Greenwich). 2025 Jun;27(6):e70079. doi: 10.1111/jch.70079.
High blood pressure (BP) is a frequent cause for visits to primary healthcare centers (PHCCs) in Sweden. Guidelines on methods for BP measurements for diagnosis of hypertension have recently been updated. We aimed to study adherence to diagnostic guidelines in hypertension management and evaluate whether adherence to guidelines was related to organizational or sociodemographic characteristics. Interviews with representatives from 76 randomly selected PHCCs from eight regions in Sweden were conducted. PHCCs' use of 24-h ambulatory BP monitoring (ABPM), home BP monitoring (HBPM) and BP measurements in both arms for the diagnosis of hypertension were chosen as proxy markers for adherence to diagnostic guidelines. An adherence index was created as a composite score of these diagnostic methods. The proportion of PHCCs stating they "often use" ABPM and HBPM were 13.7% and 16.0%, respectively, and 57.3% stated they performed BP measurements in both arms. Two PHCCs did not use ABPM, HBPM or BP measurements in both arms to diagnose hypertension. None of the organizational or sociodemographic characteristics (number of listed patients, Care Need Index (CNI), geographical location, ownership, investigation primarily led by doctor/nurse, dedicated team management, special training for hypertension and local routines) were associated with the adherence index. This study shows that adherence to diagnostic guidelines vary largely between PHCCs. No organizational characteristic, not even team-based management, was associated with adherence to diagnostic guidelines. The variation raises questions about inequity healthcare and novel strategies that may be needed to improve PHCCs' adherence to diagnostic guidelines in hypertension management. Trial Registration: ClinicalTrials.gov identifier: 263351 [www.researchweb.org].
高血压是瑞典初级医疗保健中心（PHCCs）常见的就诊原因。近期，高血压诊断的血压测量方法指南已更新。我们旨在研究高血压管理中对诊断指南的遵循情况，并评估遵循指南是否与组织或社会人口统计学特征相关。我们对从瑞典八个地区随机选取的76家PHCCs的代表进行了访谈。选择PHCCs在高血压诊断中使用24小时动态血压监测（ABPM）、家庭血压监测（HBPM）以及双侧手臂血压测量作为遵循诊断指南的替代指标。创建了一个遵循指数作为这些诊断方法的综合得分。表示“经常使用”ABPM和HBPM的PHCCs比例分别为13.7%和16.0%，57.3%的PHCCs表示他们进行了双侧手臂血压测量。有两家PHCCs在高血压诊断中未使用ABPM、HBPM或双侧手臂血压测量。组织或社会人口统计学特征（登记患者数量、护理需求指数（CNI）、地理位置、所有权、主要由医生/护士主导调查、专门团队管理、高血压专项培训和当地常规）均与遵循指数无关。本研究表明，不同PHCCs对诊断指南的遵循情况差异很大。没有任何组织特征，甚至基于团队的管理，与遵循诊断指南相关。这种差异引发了关于医疗保健不公平性的问题，以及可能需要哪些新策略来提高PHCCs在高血压管理中对诊断指南的遵循情况。试验注册：ClinicalTrials.gov标识符：263351 [www.researchweb.org]
