electronic health record analysis in the Management of essential hypertension among rural primary care patients

Kirsten Johansson; F. Berg; L. Nilsson

doi:10.5281/zenodo.22813610

Authors

Kirsten Johansson Department of Clinical Primary Care Research, Ob Academy of General and Internal Medicine Author https://orcid.org/1999-5829-8788-4267
F. Berg Department of General and Internal Medicine, Volga Institute for Advanced Primary Care Research Author https://orcid.org/7122-7317-9527-1073
L. Nilsson Department of Clinical Primary Care Research, Vistula Research Center for Primary Care Research Author https://orcid.org/1811-5673-3053-6424

DOI:

https://doi.org/10.5281/zenodo.22813610

Keywords:

electronic health records, essential hypertension, rural primary care, clinical decision support, blood pressure telemonitoring

Abstract

Graphical abstract

Background: Guideline-directed treatment of essential hypertension has grown more effective over the past two decades, yet national control rates remain near half of treated patients, with the gap widest in rural primary care.

Objective: This analysis synthesizes published evidence on electronic health record (EHR) based interventions for hypertension management and examines how their performance differs between rural and urban or academic primary care settings.

Methods: We synthesized randomized trials of EHR-embedded clinical decision support and home blood pressure telemonitoring, national guideline and surveillance documents, and observational studies reporting blood pressure control stratified by practice setting or rurality.

Results: Point-of-care decision support, home telemonitoring paired with pharmacist-led titration, and registry-driven recall each show consistent control gains over usual EHR use, while rural practices show comparable benefit once patients are enrolled but face structural barriers, staffing, travel distance, and connectivity, that limit reach and sustained use of these functions.

Conclusions: EHR presence alone does not close the rural hypertension control gap; closing it requires targeted investment in the specific decision-support, telemonitoring, and registry functions the evidence supports, sized to the staffing and infrastructure constraints of rural primary care.

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