Blood Pressure Analysis of NHANES data

Community Education
1

Some queries for reference.

select count(pid) from lists where diagnosis="ICD10:I10";

// How many patients have a diagnosis of Hypertension result: 1882

select count(distinct form_vitals.pid) from form_vitals JOIN lists on lists.pid = form_vitals.pid WHERE diagnosis="ICD10:I10" and (bps>140 or bpd>90);
// How many of those patients had BP readings "worse than 140/90"

Result: 671

select patient_data.ss as seqn,bps,bpd,form_vitals.date from form_vitals JOIN lists on lists.pid = form_vitals.pid JOIN patient_data ON patient_data.pid=form_vitals.pid WHERE diagnosis="ICD10:I10" and (bps>140 or bpd>90);
// Who were those patients who missed the goal and what were their BP readings

So for our population, on NQF 0018, Controlling Hypertension, we have a numerator of 1211 and a denominator of 1882 for which patients with hypertension have their BP controlled.

Then, looking at who didn’t have a diagnosis of hypertension but did have bp readings worse than 140/90.

select patient_data.ss as seqn ,fname, lname, bps,bpd,form_vitals.date from form_vitals, patient_data WHERE patient_data.pid = form_vitals.pid  AND (bps>140 or bpd>90) and form_vitals.pid NOT in (select pid from lists where diagnosis="ICD10:I10")

and how many

select count(distinct pid) from form_vitals WHERE  (bps>140 or bpd>90) and form_vitals.pid NOT in (select pid from lists where diagnosis="ICD10:I10");
// 430 Patients had readings of worse than 140/90 but answered "no" for both "Told had high blood pressure - 2+ times" or "Being Precribed meds for HTN"

The first patient in this list is Timothy Burke SEQN 62177. I cross referenced the answers in the original NHANES data (bpq_g) and he indeed answered no for all the questions.

2

Maybe we can run this data through the MIPS QA measure system…run for all providers and all 243 current 2017 clinical measures. This will give you the patient lists as well as everything else. It also gives you the ability to add outcomes in a very efficient way.

3

Also very interesting. Some of these patients have “white coat hypertension” and some are probably labile but, like the diabetes findings there are a lot of Americans running around with elevated BPs and BSs who have not been diagnosed. Because both are “insulin resistant” diseases, it would be interesting to know if the fasting blood sugar/A1C is higher in these un-diagnosed hypertensives than normotensive patients