Anxiety and Unrecognized High Blood Pressure in U.S. Ambulatory Care Settings: An Analysis of the 2005 National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey

Abstract

Objective: To determine for U.S. ambulatory visits for anxiety how often high blood pressure is unrecognized and the factors associated with being unrecognized. Methods: Analyzed data from the 2005 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey looking at visits for anxiety by patient complaint or provider diagnosis and determined if a hypertension diagnosis was included for visits in which measured blood pressure was in the hypertensive range. This was compared to total visits in the NAMCS and NHAMCS. Logistic regression determined predictors of high blood pressure going unrecognized for visits for anxiety. Results: Of visits for anxiety in 2005 with elevated blood pressure, 32.5% were unrecognized. This compares to 24.6% unrecognized for all visits with hypertension/elevated blood pressure. At visits in which anxiety medications were prescribed (OR 2.44 95%CI 1.01–5.89) and for Hispanic ethnicity (OR 13.9 95%CI 1.46–132.03), high blood pressure was more likely to be unrecognized. High blood pressure was less likely to be unrecognized for those 45 to 64 years old (OR 0.21 95%CI 0.07–0.62), visits not with the primary care provider (OR 0.09 95%CI 0.03–0.33), visits for a chronic problem (OR 0.26 95%CI 0.08–0.86), and visits at which anti-hypertensive medications were prescribed (OR 0.005 95%CI 0.001–0.04). Conclusions: Anxiety is a common reason for visits in U.S. ambulatory settings. Many of these visits have concomitant high blood pressure, a large proportion of which may go unrecognized. Efforts to educate physicians about these issues may help reduce the level of unrecognized high blood pressure in those with anxiety.