20-05-2025
Improving End Organ Checks in Outpatient Hypertension
Providers should evaluate all patients with new-onset hypertension for evidence of end organ damage, guidelines say, but researchers have found gaps in that process.
Researchers at Indiana University School of Medicine's Southwest Internal Medicine Residency Program, including Mark Georgy, MB BCh, presenting author, noted that new-onset hypertension is commonly diagnosed in the outpatient setting by primary care providers.
Organ dysfunction secondary to hypertension was not being monitored appropriately at their own outpatient residency clinic, so they suspected that may be the case elsewhere. The team set out to find a way to improve the evaluation of end organ damage and presented their findings in a poster at Society of General Internal Medicine (SGIM) 2025 Annual Meeting in Hollywood, Florida.
First, they looked at why the end organ evaluations weren't being done and found that unfamiliarity with the most recent guidelines was a significant factor, followed by lack of resources in the clinic that providers could easily reference. A lack of streamlined order sets within the electronic medical record (EMR) was also an issue.
Multipronged Intervention
The researchers developed 30-minute interactive seminars for small groups of residents and created and printed posters detailing algorithms and made them readily available in multiple areas of the resident clinic work area. They also developed an order set for the EMR that included all the workup required to evaluate end organ damage according to guidelines.
Their measures of success were increases in evaluating end organ damage and, through survey responses, how the resources were received by residents and attending physicians.
While the qualitative results were not available by the poster deadline, the authors wrote, the survey responses show the intervention was well received. They added that their approach was designed to allow other programs to easily replicate the steps.
'Most complimented have been the interactive seminars, with most noting the wealth of useful knowledge gained in an engaging yet efficient format. Posters were deemed easy to interpret and a useful tool to reinforce knowledge,' the authors reported. 'The order sets were found to make workflow more streamlined.'
Complex Guidelines May Feed Problem
Donald DiPette, MD, clinical professor of internal medicine at University of South Carolina School of Medicine Columbia, told Medscape Medical News the lack of end organ damage evaluation in hypertension is a common gap in care far beyond the group studied here.
He said the number and length of guidelines may well contribute to the gap and make it difficult for primary care physicians to easily access guidance on best practices.
Additionally, he said, it's also common to not act on the signs of end organ damage even after it is identified.
Reasons for that are that the guidelines 'are overly comprehensive and that makes them overly complicated,' he said. 'Even the executive summaries are overly complicated. Most guidelines are written by subspecialists and not necessarily aimed at the primary care physician.'
What's Missed Without the Evaluation
DiPette explained the need for the end organ evaluation. The elevated pressure damages primarily the heart, the brain, and the kidneys. It's a vicious cycle, DiPette said, because 'if you develop the end organ damage either from the hypertension or another disease that causes the end organ damage, that damage can further elevate the blood pressure. One of the reasons the evaluation is so important is to break that cycle.'
Finding the end organ damage may also change the level of blood pressure physicians treat. 'In most of the guidelines now, if you have end organ damage like heart disease or kidney disease or diabetes, you would treat patients at a lower blood pressure level,' he explained. That, in turn, changes the target blood pressure you want to achieve.
It also might influence the medications you choose, DiPette said. 'Some of the blood pressure medicines can lower blood pressure and help the organ,' he said. 'There also may be medications you want to add to further treat the patient's organ damage at the same time you're lowering the blood pressure.'
He said these researchers are 'likely onto something' with their intervention. 'I like their idea of utilizing the electronic medical records,' DiPette said. 'We often are pretty critical of electronic medical records as physicians, but there's really some positive benefits of an EMR and this is one of them.'
'Any positive acknowledgment of the problem and ways to address it brings the issue to light.' Then professionals are more likely to not only investigate for the presence of end organ damage but also act upon it, he said.
DiPette declared having no relevant financial relationships. He was part of a leadership team that developed World Health Organization guidelines on hypertension. Authors reported having no relevant financial relationships.
