Trends in screening and treating adults for hypertension and lipid disorders in office based physician practice in the United States, 2001-2006

Background and objectives: Heart disease remains the leading cause of mortality in America. Screening and treatment for hypertension and hyperlipidemia are among the effective strategies to reduce risk for cardiovascular disease. However, heart disease prevention in primary care practice on the national level has not been well documented. This study examines the trends in blood pressure checks and cholesterol/lipids testing provided or ordered and medication treatment for hypertension and hyperlipidemia during patient encounters with primary care providers in office based practice.

Study design and methods: This study uses data from National Ambulatory Medical Care Survey (NAMCS), a nationally-representative survey of visits to office-based physicians excluding anesthesiologists, radiologists, and pathologists. Six years of NAMCS data from 2001 to 2006 were used for the analysis. Only visits by adults age 18 years and over to primary care providers, including family physicians, generalists, internists, and OB/GYNs were examined. Data were weighted to produce national annual estimates. Two years of data were combined to make more reliable point estimates. A Wald F test of the joint significance of year dummies for 2001-2002, 2003-2004, 2005-2006 was used to test the significance of trends.

Principal findings: Blood pressure checks increased from 74.8 percent of patient visits in 2001-2002 to 81.3 percent in 2003-2004 and to 88.2 percent in 2005-2006 (p<0.001). The provision or orders of diuretics and beta blockers to patients with uncomplicated hypertension during patient office visits with primary care providers also increased from 32.9 percent in 2001-2002 to 42.5 percent in 2005-2006 (p<0.002). There was a significant increase in screening for lipid disorders by providing or ordering cholesterol/lipids tests. Statins used to lower hyperlipidemia were prescribed or provided to patients during 38.1 percent of patient visits in 2001-2002 and 46.8 percent (p<0.02) of patient visits in 2005-2006.

Conclusion: There were significant upward trends in screening and treatment for hypertension and lipid disorders in primary care practice. The findings suggest improved compliance with clinical guidelines in providing effective heart disease preventive care among primary care providers. Since hypertension and hyperlipidemia control remain suboptimal, the provision of heart disease preventive care in clinical settings needs to be continuously monitored and further improved.