{"doi":"10.1001/jamanetworkopen.2025.20498","title":"Delayed Hypertension Diagnosis and Its Association With Cardiovascular Treatment and Outcomes","abstract":"Importance: Hypertension is a major risk factor for cardiovascular disease, yet delays in diagnosis may limit timely treatment initiation and increase cardiovascular risk. Objectives: To examine the timing of clinical hypertension diagnosis, its association with antihypertensive medication prescribing, and its association with long-term cardiovascular outcomes. Design, Setting, and Participants: This retrospective cohort study analyzed electronic health record (EHR) data from an integrated health care system. Adults aged 18 to 85 years with at least 2 outpatient blood pressure (BP) readings of 140/90 mm Hg or more recorded at least 30 days apart from January 1, 2010, to December 31, 2021, were included (meeting BP-based criteria for hypertension as recorded in the EHR; ie, a \"computed hypertension diagnosis\"). Data were analyzed from January to November 2023. Exposures: The timing of clinical hypertension diagnosis (the formal recorded diagnosis by a clinician) relative to the second elevated BP measurement was categorized as (1) preexisting diagnosis; (2) diagnosed between the first and second BP elevations (reference group); (3) diagnosed after the second BP elevation, subdivided into 1 to 90 days, 91 to 365 days, or more than 365 days after the second BP elevation; and (4) no recorded diagnosis. Main Outcomes and Measures: The primary outcome was antihypertensive medication prescription within 30 days of diagnosis. The secondary outcome was the 5-year composite risk of myocardial infarction, ischemic stroke, or heart failure hospitalization. A multivariable Cox proportional hazards regression model estimated hazard ratios (HRs) for cardiovascular outcomes, adjusting for demographics, BP, and comorbidities. Results: Among 311 743 patients with a computed hypertension diagnosis, 14.6% received a diagnosis after the second BP elevation (mean [SD] age 57.9 [13.1] years; 53.3% women; 69.6% non-Hispanic White, 24.9% non-Hispanic Black, 2.4% Hispanic or Latino, and 1.7% non-Hispanic Asian). Delayed diagnosis was associated with lower antihypertensive medication prescription rates (30.6% vs 75.2%; P < .001) and increased cardiovascular risk over 5 years (delay of 1-90 days: HR, 1.04 [95% CI, 0.95-1.13]; delay of 91-365 days: HR, 1.11 [95% CI, 1.04-1.19]; and delay of >365 days: HR, 1.29 [95% CI, 1.23-1.36]). Greater delay in clinical diagnosis of hypertension was associated with younger age (45-64 years: median delay, 17.5 months [IQR, 6.1-34.6 months] vs ≥75 years: median delay, 13.4 months [IQR, 4.7-28.2 months]; P < .001), female sex (median delay, 16.6 months [IQR, 5.8-33.7 months] vs male sex: median delay, 16.1 months [IQR, 5.7-33.1 months]; P < .001), and non-Hispanic Asian or non-Hispanic Black race (non-Hispanic Asian: median delay, 18.5 months [IQR, 6.9-34.0 months]; non-Hispanic Black: median delay, 17.2 months [IQR, 5.8-34.9 months]; vs non-Hispanic White: median delay, 16.3 months [IQR, 5.9-33.3 months]). Conclusions and Relevance: This study suggests that delays in hypertension diagnosis were common and significantly associated with delays in treatment initiation and adverse cardiovascular outcomes, underscoring the need for earlier identification and intervention.","journal":"JAMA Network Open","year":2025,"id":511593,"datarank":0.42498200160843247,"base_score":2.833213344056216,"endowment":2.833213344056216,"self_citation_contribution":0.42498200160843247,"citation_network_contribution":0.0,"self_endowment_contribution":0.42498200160843247,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":16,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9217,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1369613,"name":"John E. Brush","orcid":"0000-0001-8192-494X","position":1,"is_corresponding":false},{"id":588675,"name":"Chungsoo Kim","orcid":"0000-0003-1802-1777","position":2,"is_corresponding":false},{"id":829353,"name":"Yuntian Liu","orcid":"0000-0001-6571-6112","position":3,"is_corresponding":false},{"id":1369614,"name":"Xin Xin","orcid":"0000-0002-0223-923X","position":4,"is_corresponding":false},{"id":815497,"name":"Chenxi Huang","orcid":"0000-0001-8624-4652","position":5,"is_corresponding":false},{"id":1130676,"name":"Mitsuaki Sawano","orcid":"0000-0003-2789-1758","position":6,"is_corresponding":false},{"id":657015,"name":"Patrick Young","orcid":"0000-0002-7584-6807","position":7,"is_corresponding":false},{"id":554193,"name":"Jacob McPadden","orcid":"0000-0001-8625-181X","position":8,"is_corresponding":false},{"id":1369615,"name":"Mark Anderson","orcid":"0000-0001-5177-0716","position":9,"is_corresponding":false},{"id":1370345,"name":"John S. Burrows","orcid":null,"position":10,"is_corresponding":false},{"id":1369616,"name":"Jordan Asher","orcid":"0009-0006-4664-3847","position":11,"is_corresponding":false},{"id":1077,"name":"Harlan M. Krumholz","orcid":"0000-0003-2046-127X","position":12,"is_corresponding":false},{"id":490034,"name":"Yuan Lü","orcid":"0000-0003-0613-4336","position":0,"is_corresponding":true}],"reference_count":21,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-19T02:47:55.918021Z","pmid":"40658418","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}