{
  "abstract": "Introduction Hypertension is a major modifiable risk factor for major adverse cardiovascular events (MACE)[1]. Hypertension has the strongest evidence for causation of cardiovascular disease including coronary heart disease, heart failure and atrial fibrillation. The QRISK3 score estimates the 10-year risk of a primary cardiovascular event[2], and even modest blood pressure reductions can be beneficial for prevention of primary and secondary cardiovascular risk[3]. Specialist clinics assist in the investigation and management of high-risk patients.This quality improvement project evaluates the care pathway for patients referred from acute and inpatient services to the hypertension clinic.Methods We conducted a retrospective analysis of patients referred to the hypertension clinic in a large tertiary hospital. We focused on 1) baseline clinical assessment, 2) specialist review, and 3) patient outcomes.Results Between December 2023 and October 2024, 84 patients were referred to the hypertension clinic. The patients were equally split between female and male, and mostly Caucasian (33.3%) and Asian (27%). Most patients referred had Stage 3 hypertension (61%, 51/84), and the mean presenting systolic and diastolic blood pressure was 186±29 and 106±22 mmHg, respectively. Median follow-up was 428 (313–486) days.QRISK3 score had not been calculated for any of these patients. Electrocardiography was reviewed in 48% (40/84), and left ventricular hypertrophy was identified in 20% of those screened (10/40). Additionally, 52% (44/84) patients were screened for renal impairment, and 14% (6/44) had confirmed damage.Median time from referral to specialist review was 157 (88–287) days. While 69% (58/84) were scheduled an appointment, 7 did not attend. Notably, 31% of referrals did not result in a clinic booking. Indications included young-onset (50%) and resistant (37%) hypertension. Outcomes from specialist clinic review were medication optimisation (28%), further investigations (26%) (echocardiography, ambulatory blood pressure monitoring and renal artery imaging), and onward specialist referrals (8%).During the follow-up period, 7% (6/84) experienced a MACE, including myocardial infarction (n = 2), stroke/transient ischaemic attack (n = 2), and heart failure (n = 2). Patients reviewed in the specialist clinic had fewer MACE compared to those not seen, but this was not statistically significant (5.9% vs 9.1%, Fisher’s Exact Test p=0.658).Conclusion Patients referred to the specialist hypertension clinic were at high cardiovascular risk with a high prevalence of end-organ damage. Clinical assessment was inconsistent, likely leading to underdiagnosis of end-organ damage. It is possible that the patients that were not booked did not meet the criteria for referral. A standardised assessment pathway would ensure thorough risk stratification and improved booking will ensure improved patient outcomes.",
  "authors": [
    {
      "affiliations": [
        "Department of Acute Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom"
      ],
      "name": "Jun Yu Chen"
    },
    {
      "affiliations": [
        "Department of Acute Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom"
      ],
      "name": "Stewart Morton"
    },
    {
      "affiliations": [
        "Department of Acute Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom"
      ],
      "name": "Sanjana Narayan"
    },
    {
      "affiliations": [
        "Department of Acute Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom"
      ],
      "name": "Aali Mughal"
    },
    {
      "affiliations": [
        "Department of Acute Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom"
      ],
      "name": "Murtaza Nomani"
    },
    {
      "affiliations": [
        "Department of Acute Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom"
      ],
      "name": "Ashin Varghese"
    },
    {
      "affiliations": [
        "Department of Acute Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom"
      ],
      "name": "Vinay Reddy-Kolanu"
    }
  ],
  "title": "552 An opportunity to reduce major adverse cardiovascular events in patients presenting with stage 3 hypertension at a tertiary centre",
  "uid": "7c969a5a-07af-5ad0-a60d-b5c4c2ed98fc"
}