Determination of critical indicators for identifying hypertension patients at high risk of complications: a literature review-based Delphi study and a preliminary empirical analysis

Abstract

ObjectiveTo explore critical indicators for identifying hypertension patients at high risk of hypertension-related complications for prevention and control of complications among community hypertension patients. Methods With boundary analyses, the checklists of major hypertension complications and their risk factors were established through systematic reviews on hypertension-related literatures published domestically and internationally up to April 2021, including 275 research articles, 36 entries on websites of professional institutions, 89 entries on official websites of organizations and associations, 529 entries on social medium websites, 10 guidelines and standards issued by professional institutions, and 7 professional books. Three rounds of expert consultations involving 34 experts were conducted to screen out critical indicators of hypertension complications in the checklist established. Using the screened-out critical indicators and electric health records of 62 150 community hypertension patients registered from January 2014 through January 2020 in Minhang district of Shanghai city, a subsequent empirical analysis was performed on the data on 37 483 hypertension patients without complications at the enrollment of community-based disease management. ResultsTotally 13 critical indicators for hypertension complications were identified, including poor blood pressure control, high salt diet, overweight/obesity (body mass index ≥ 24.0), irregular medication, aged ≥ 60 years, smoking, excessive drinking, family history of cardiovascular disease, abdominal obesity, long disease course, dyslipidemia, lack of physical exercise, and psychological pressure. The three rounds of expert consultation achieved positive coefficients of 100.0%, 100.0%, and 91.2% and authority coefficients of 0.86, 0.86, and 0.88, respectively; the expert opinion coordination coefficient was 0.281 for the first round (P < 0.05), indicating a good agreement among the experts. Resulted from the expert consultations, the hypertension patients with 5 or more of the 13 critical indicators could be assessed as being at high risk of hypertension-related complications. The assessment based on the analysis result indicated that 9.17% of the individuals were at high-risk of complications among 37 483 community hypertension patients without hypertension-related complications previously diagnosed. ConclusionThe critical indicators established in this study could be adopted conveniently in rapid identification of individuals at high risk of complications among community hypertension patients.

Keywords

• hypertensive complication
• high-risk groups
• rapid identification method
• development
• empirical analysis