Indicators of quality of care for hypertension in women

1. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) should be measured in adult women otherwise presenting for care at least once each year.

2. Patients with new diagnosis of stage 1-3+ hypertension should have at least 3 measurements on different days with a mean SBP of >140 mm Hg and/or a mean DBP of 99 mm Hg.

3. Initial history and physical examination of patients with hypertension should document assessment of at least 2 items from each of these groups:

— History: Family or personal history of premature coronary artery disease, cardiovascular disease, diabetes, or hyperlipidemia.

— Medication or substance use: Personal history of tobacco abuse, alcohol abuse, or taking medications that may cause hypertension.

— Physical examination: Examination of the fundi, heart sounds, abdomen for bruits, peripheral arterial pulses, and neurologic system.

4. Stage 1+ hypertensive women taking drugs that may cause hypertension should have the drug discontinued (at least temporarily) before pharmacotherapy is initiated:

  • Oral contraception
  • Nasal decongestants
  • Appetite suppressants
  • Monoamine oxidase inhibitors
  • Tricyclic antidepressants

5. Initial laboratory tests should include:

  • Urinalysis
  • Glucose
  • Potassium
  • Creatinine
  • Cholesterol
  • Trigylceride

6. Patients with average blood pressure of >140 mm Hg systolic and/or >90 mm Hg diastolic, as determined on at least 3 separate visits, should have a diagnosis of hypertension documented in their record.

7. First-line treatment for hypertension is lifestyle modification. The medical record should indicate counseling for at least 1 of the following interventions before pharmacotherapy:

  • Weight reduction
  • Increased physical activity
  • Low-sodium diet
  • Alcohol intake reduction

8. First-line treatment for stage 3+ hypertension is lifestyle modification. The medical record should indicate counseling for at least 1 of the following interventions:

  • Weight reduction
  • Increased physical activity
  • Low-sodium diet
  • Alcohol intake reduction

9. Stage 1-2+ hypertensive patients whose blood pressure remains stage 1-2+ after 6 months of lifestyle modification should receive pharmacotherapy.

10. Stage 3+ hypertensive patients should receive pharmacotherapy.

11. First-line pharmacotherapy for diabetic patients should include an ACE inhibitor or a calcium channel blocker.

12. Hypertensive patients should visit the provider at least once a year.

13. Hypertensive patients with persistent elevations of SBP of >160 mm Hg or DBP of >90 mm Hg should have 1 of the following interventions recorded in the medical record:

  • Change in dose or regimen of hypertensive agents
  • Repeated education regarding lifestyle modifications

Source: Asch SM, Kerr EA, Lapuerta P, et al. A new approach for measuring quality of care for women with hypertension. Arch Intern Med 2001; 161:1,329-1,335.