Blood pressure and cholesterol measurements in primary care: cross-sectional analyses in a dynamic cohort

Abstract

Background: Guidelines on cardiovascular risk management (CVRM) recommend blood pressure (BP) and cholesterol measurements every 5 years in men aged ≥40 years and (post-menopausal) women aged ≥50 years. Aim: To evaluate CVRM guideline implementation. Design & setting: Cross-sectional analyses in a dynamic cohort using primary care electronic health record (EHR) data from the Julius General Practitioners’ Network (JGPN) (n = 388 929). Method: Trends (2008–2018) were assessed in the proportion of patients with at least one measurement (BP and cholesterol) every 1, 2, and 5 years, in those with: 1. a history of cardiovascular disease (CVD) and diabetes mellitus (DM); 2. a history of DM only; 3. a history of CVD only; 4. a cardiovascular risk assessment (CRA) indication based on other medical history, or; 5. no CRA indication. Trends were evaluated over time using logistic regression mixed-model analyses. Results: Trends in annual BP and cholesterol measurement increased for patients with a history of CVD from 37.0% to 48.4% (P<0.001) and 25.8% to 40.2% (P<0.001). In the 5-year window from 2014– 2018, BP and cholesterol measurements were performed respectively in 78.5% and 74.1% of all men aged ≥40 years and 82.2% and 78.5% of all women aged ≥50 years. Least measured were patients without a CRA indication (men 60.2% and 62.4%; women 55.5% and 59.3%). Conclusion: The fairly high frequency of CVRM measurements available in the EHR of patients in primary care suggests an adequate implementation of the CVRM guideline. As nearly all individuals visit the GP at least once within a 5-year time window, improvement of CVRM remains possible, especially in those without a CRA indication.