HYPERTENSION SCREENING IN SWEDISH PRIMARY HEALTHCARE: RESULTS FROM A HEALTH UTILIZATION COHORT

Objective: Detecting hypertension is crucial for preventing cardiovascular disease, yet 51% of men and 46% of women with hypertension in Sweden remain undiagnosed. Stockholm County does not have a systematic screening program, and limited opportunistic screening may contribute to underdiagnosis. However, information on screening practices within healthcare is lacking. Here we aimed to estimate the occurrence of hypertension screening at primary healthcare centres in Stockholm County. Design and method: We analysed electronic health records data from the Care for METabolic risk factors in primary CARE centres (MetCare) cohort (2015–2023) for 687,934 individuals without a prior hypertension diagnosis. We used Poisson regression to estimate annual screening rates, including subgroup analyses by hypertension risk (overweight, obesity, unhealthy living habits, age 50 years or older, or previous type 2 diabetes, cardiovascular- or chronic kidney disease). Finally, we followed up individuals without hypertension after 5 years and estimated the proportion who had been screened for hypertension. Results: On average, 15.2% (95% CI 0.152–0.153) of adults without hypertension were screened annually, with a marked decline during COVID-19 (2.3 percentage points). Women were screened 7 percentage points more than men, irrespective of age. Screening was more frequent in high-risk individuals (23.8%, 95% CI 0.238–0.239) but declined by 2.1 percentage points during the study period. The decrease over time was even larger (6.8 percentage points) among individuals with prior cardiometabolic disease. The proportion of the population of higher risk grew larger during the study period, but their visits to the primary healthcare centres declined. After five years, 38% of high-risk individuals remained unscreened, including 13% who had not visited primary healthcare centres. Conclusions: Limited screening contributes to underdiagnosis, particularly among men. Alarmingly, screening in risk groups declined over time. Strengthened resources and support systems are required to enhance opportunistic screening in primary healthcare among those at risk, especially men. Additional strategies are required to reach people at risk who do not seek care.