Heart, Lung and Circulation

Retrospective Audit of Hypertension Management in a Chronic Disease Management Unit at a Major Tertiary Hospital in Australia

      Hypertension is a known cardiovascular risk factor and treatment has been shown to reduce cardiovascular morbidity and mortality. The objective of this study was to evaluate hypertensive management in an outpatient clinic according to current Heart Foundation of Australia guidelines. A retrospective audit of all patients’ records from their appointment in the month of May 2010 was conducted. A database was made of patients’ blood pressure and co-morbid diseases in a spreadsheet and whether their blood pressure medication had been changed. 137 patients were included. Fifty-nine patients had diabetes mellitus and 60 of the 127 patients had ischaemic heart disease as co-morbidities. On 32 occasions, patients with diabetes and/or ischaemic heart disease recorded a systolic blood pressure greater than 130 mm Hg or a diastolic greater than 80 mm Hg. Only one of these 32 patients had their blood pressure therapy adjusted by the addition of a new medication or an increased dose of a pre-existing tablet. Ten patients without diabetes or ischaemic heart disease recorded a blood pressure systolic greater than 140 mm Hg or diastolic greater than 90 mm Hg. An appropriate change according to guidelines occurred in five patients. Results indicate that blood pressure management is suboptimal. Reasons for under-treatment may include therapeutic inertia, lack of time, lack of knowledge and competing management priorities. Subsequent changes to the clinic electronic record now incorporate guidelines for management of diabetes, and IHD. Mandatory tick boxes form part of the electronic record indicating guideline adherence or reasons for non-adherence, allowing us to more readily track out performance.