Barriers for Secondary Hypertension Screening in the United States: A National Physician Survey

BACKGROUND: Hypertension affects almost half of US adults and is a major cause of cardiovascular morbidity and mortality. Although expert guidelines recommend screening for secondary hypertension in patients with treatment-resistant hypertension and other high-risk groups, screening is conducted in <2% of candidates. This study aimed to determine barriers for secondary hypertension screening across US practices. METHODS: Primary care physicians, cardiologists, nephrologists, and endocrinologists, randomly selected from active members of the American Medical Association, were surveyed on barriers for secondary hypertension screening. RESULTS: Response rate was 67% (425 of 633 response-eligible physicians). The leading reported barriers preventing secondary hypertension screening included visit time constraints (43.5%), poor ancillary support (29.4%), and testing-related logistics (27.5%). Primary care physicians were 10- to 17-fold less likely to be familiar with testing interpretation and subsequent steps than nephrologists and endocrinologists. Physicians in practices covered largely by Medicare were twice more likely to report poor ancillary support than physicians in practices covered primarily by private health insurance. Private practice physicians were more likely to report reimbursement concerns (adjusted odds ratio, 3.4 95% CI, 1.6-7.7) and poor ancillary support (adjusted odds ratio, 2.1 95% CI, 1.3-3.6) but also more likely to have access to specialists (adjusted odds ratio, 4.0 95% CI, 1.2-13.5) than physicians practicing in large medical groups. CONCLUSIONS: Our findings call for measures to address critical barriers in secondary hypertension screening. Strategies needed to facilitate personalized hypertension care include optimization of clinic visit duration, ancillary support, education initiatives, and timely access to specialists.