Provider-Documented Reasons for Uncontrolled Hypertension in Adolescents and Young Adults at Elevated Cardiovascular Risk

Background: Adolescents and young adults with diabetes or CKD are at elevated cardiovascular (CV) risk. Yet, blood pressure (BP) control is suboptimal in this group, with only 38% of young adults achieving appropriate control compared to 55% in middle-aged adults and 53% in older adults. The study aimed to identify provider-documented reasons for failure to achieve appropriate BP control during the longitudinal care of adolescents and young adults at elevated CV risk. Methods: We conducted a qualitative study of patients aged 13-39 seen in nephrology and endocrinology clinics at a single center from January 2018 to December 2023 (n = 35). Patients with CKD or diabetes (type 1 or 2) and uncontrolled hypertension - defined as two clinic BP readings >130/80 mmHg 90 days apart or ongoing anti-hypertensive therapy were included. Provider notes were reviewed using inductive coding to identify provider-documented reasons for failure to achieve BP control (defined as clinic BP <130/80 mmHg). After synthesizing themes via inductive analysis, notes were re-reviewed using a deductive approach. Mixed-effect linear regression models were used to test for differences in SBP over time. Results: We included 35 patients for study (Table 1). 25% were adolescents, 46% were women, and median time to BP control or censoring was 229.0 weeks. Themes explaining the failure to achieve clinic BP targets included provider perceptions of patient non-adherence to medications, inconsistent home BP monitoring, and provider distrust of BP data (obtained either in the clinic or at home). Higher baseline SBP was associated with higher SBP over time (ß=0.05 mmHg increase per week, 95% CI 0.02-0.07, p<0.001), and no change in SBP was observed over time (p=0.2). Even among patients who eventually achieved BP control, median time to control was 93 weeks (Table 1). Conclusion: Our findings highlight significant delays in achieving appropriate BP control in high-risk adolescents and young adults with diabetes or CKD, potentially due to provider perceived patient non-adherence or distrust of BP data. Funding: Other NIH Support - NHLBI