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Concept DescriptionIntroductionThis concept contains information on how hypertension has been defined in MCHP research in order to measure the prevalence of this medical condition. This includes the data sources that are used, the ICD codes that define this condition, and the antihypertensive prescription drugs that are used to treat hypertension.Hypertension is a disorder characterized by high blood pressure; generally this includes systolic blood pressure consistently higher than 140, or diastolic blood pressure consistently over 90. "Essential" hypertension has no identifiable cause. It may have genetic factors and environmental factors, such as salt intake or others. Essential hypertension comprises over 95% of all hypertension. "Secondary" hypertension is hypertension caused by another disorder.Literature ReviewA number of studies have used administrative data to measure the prevalence of hypertension. Both narrow and broader ranges of ICD-9-CM codes have been used in previous research. Table 1 summarizes six studies, published prior to 2006, that used administrative data to ascertain cases of hypertension.Manitoba Hypertension AlgorithmsThe following algorithms have been described and validated in previous research using Manitoba data.DATA SOURCES:In the following algorithms: 1. Robinson et al. (1997)In Robinson et al. (1997), the following ICD-9-CM codes were used to define hypertension cases:401: Essential hypertension402: Hypertensive renal disease403: Hypertensive renal disease404: Hypertensive heart and renal disease405: Secondary hypertension642: Hypertension in pregnancy362.11: Hypertensive retinopathy416.0: Primary pulmonary hypertension437.2: Hypertensive encephalopathy796.2: Elevated blood pressure without hypertension.Robinson used both hospital and physician data to identify hypertension cases, and investigated the effect of the change in the number of years of data and the number of required diagnoses on agreement between administrative data and Manitoba Heart Health Survey data. The respondents were 18 to 74 years of age.2. Muhajarine et al. (1997)In Muhajarine et al. (1997), the following ICD-9-CM codes were used to define hypertension cases:401: Essential hypertension4. Lix et al. (2008)Lix et al. (2008) provided an update to the 2006 study with a report titled Defining and Validating Chronic Disease: An Administrative Data Approach. An Update with ICD-10-CA. The purpose of the 2008 report is to examine the validity of administrative data for monitoring the prevalence of chronic disease in Manitoba. Specific objectives are:Report relevant ICD-10-CA codes for ascertaining cases of chronic disease in administrative health data;Evaluate the validity of multiple algorithms for identifying disease cases from Manitoba administrative data.The 2008 report uses the same methods and algorithms as described in the 2006 report, with the following modifications:ICD-10-CA codes were used to define specific chronic diseases from hospital separation data, beginning April 1, 2004. This is due to a change in coding systems used in Manitoba hospitals. The same ICD-9-CM codes identified in the 2006 report were used to identify hospital cases prior to April 1, 2004.data from the Canadian Community Health Survey (CCHS), cycle 3.1, collected from January 2005 to January 2006 were used to evaluate the validity of the administrative data. The cohort consisted of 5,099 adults 19+ years of age.additional algorithms looking at different combinations of hospital cases, or physician claims and/or prescriptions over one, two and three years, as well as additional algorithms using five years of data.The following ICD-10-CA codes were used to define hypertension in administrative hospital separation data from April 1, 2004 to March 31, 2006:5. Fransoo et al. (2009), Martens et al. (2010), Fransoo et al. (2011), Chartier et al. (2012), and Fransoo et al. (2013)In the following deliverables:one or more hospitalizations with a diagnosis of hypertension: ICD-9-CM codes 401-405 OR ICD-10-CA codes I10-I13, I15; ORone or more physician visits with a diagnosis of hypertension: ICD-9-CM codes 401-405; ORtwo or more prescriptions for hypertension drugs (see list below).List of drugs / medications used to treat hypertension (with ATC codes) - from individual MCHP reports:**NOTE:In the Obesity deliverable, for participants of the Manitoba Heart Health Survey (MHHS) who were surveyed in 1989-1990, there is no prescription data available. The Drug Program Information Network (DPIN) data is only available from 1995 onwards. Therefore, in this study, the definition of hypertension for MHHS participants is:one or more hospitalizations in three years with a diagnosis of hypertension (ICD-9-CM codes as above), or6. Finlayson et al. (2010)Finlayson et al. (2010) define hypertension as one or more hospitalizations OR one or more physician visits OR two or more prescriptions over a two-year time period for those aged 19+ where the events are coded with an ICD code representing hypertension or a prescription is dispensed for a hypertension medication.7. Heaman et al. (2012)In Heaman et al. (2012), a woman was considered to have maternal hypertension if in the one year prior to giving birth she had:at least one physician visit or one hospitalization (ICD-9-CM codes 401-405 or ICD-10-CA codes I10-I13, I15); ORtwo or more prescriptions for hypertension drugs:Anti-hypertensives (C02AB01, C02AB02, C02AC01, C02CA04, C02CA05, C02DB02, C02DC01, C02KX01, C02LA01, C02LB01, G04CA03);Diuretics (C03AA03, C03BA04, C03BA11, C03CA01, C03CA02, C03CC01, C03DA01, C03DB01, C03DB02, C03EA01);Beta Blocking Agents (C07AA02, C07AA03, C07AA05, C07AA06, C07AA12, C07AB02, C07AB03, C07AB04, C07AB07, C07AG01, C07BA05, C07BA06, C07CA03, C07CB03);Calcium Channel Blockers (C08CA01, C08CA02, C08CA04, C08CA05, C08CA06, C08DA01, C08DB01);Agents Acting on the Renin-Angiotensin System (C09AA01, C09AA02, C09AA03, C09AA04, C09AA05, C09AA06, C09AA07, C09AA08, C09AA09, C09AA10, C09BA02, C09BA03, C09BA04, C09BA06, C09BA08, C09CA01, C09CA02, C09CA03, C09CA04, C09CA06, C09CA07, C09DA01, C09DA02, C09DA03, C09DA04, C09DA06, C09DA07)8. Katz et al. (2013)In Katz et al. (2013) they investigated the patterns of ambulatory care services (see Ambulatory Visits - Physician) delivered by primary care and specialist physicians to Manitobans with one of six chronic conditions, including hypertension. This study focused on Manitobans aged 19 and older over a three-year period (plus one-year follow-up) and measured how these patterns of care impact on the quality of care received. They defined hypertension as:at least one hospital diagnosis: hypertensive diseases (ICD10-CA codes: I10-I15) in three years OR at least two ambulatory visit diagnoses: hypertensive diseases (ICD-9-CM codes: 401-405) in three years ORat least two prescriptions for any of the following: anti-hypertensives (ATC codes: C02AB01, C02DC01), diuretics (ATC codes: C03BA11, C03DB02), beta blocking agents (ATC codes: C07AA12, C07AB03, C07CA03), calcium channel blocker (ATC codes: C08DA01), angiotensin converting enzyme inhibitors (ACEI; ATC codes: C09AA05, C09BA02), angiotensin II antagonists (ATC codes: C09CA01, C09DA01) in three years.9. Martens et al. (2015)In The Cost of Smoking: A Manitoba Study deliverable by Martens et al. (2015) they calculated hypertension prevalence rates two ways; one using administrative data and the other using self-reported survey data. Using the administrative data, the weighted crude prevalence of hypertension was calculated for survey respondents aged 12 and older in the two years before their survey date. Hypertension was defined by one of the following conditions:one or more hospitalizations with a diagnosis of hypertension, ICD-9-CM codes 401-405; ICD-10-CA codes I10-I13, I15; or10. Chartier et al. (2015)In the Care of Manitobans Living with Chronic Kidney Disease deliverable by Chartier et al. (2015) they investigated the prevalence and relative risk of hypertension as a comorbidity to chronic kidney disease (CKD) and end stage kidney disease (ESKD). Hypertension was defined as Manitoba residents receiving one of the following diagnoses or prescriptions in the one-year fiscal period 2011/12, using the following algorithm:Age groups:Children: 0-17 years oldAdults: 18 years and olderCodes and Conditions:one or more inpatient hospitalizations for hypertensive disease (ICD-9-CM: 401-405 OR ICD-10-CA: I10-I13, I15); orone or more physician claims for hypertensive disease (prefix=7, ICD-9-CM: 401-405); orone or more prescriptions for antihypertensive drugs, diuretics, beta blocking agents, calcium channel blockers, agents acting on the renin-angiotensin system, atorvastatin, or terazosin with the following ATC codes: C02AB01, C02AB02, C02AC01, C02CA04, C02CA05, C02DB02, C02DC01, C02LA01, C02LB01, C03AA03, C03BA04, C03BA11, C03CA01, C03CA02, C03CC01, C03DA01, C03DB01, C03DB02, C03EA01, C07AA02, C07AA03, C07AA05, C07AA06, C07AA12, C07AB02, C07AB03, C07AB04, C07AB07, C07AG01, C07BA05, C07BA06, C07CA03, C07CB03, C08CA01, C08CA02, C08CA04, C08CA05, C08CA06, C08DA01, C08DB01, C09AA01, C09AA02, C09AA03, C09AA04, C09AA05, C09AA06, C09AA07, C09AA08, C09AA09, C09AA10, C09BA02, C09BA03, C09BA04, C09BA06, C09BA08, C09BB10, C09CA01, C09CA02, C09CA03, C09CA04, C09CA06, C09CA07, C09CA08, C09DA01, C09DA02, C09DA03, C09DA04, C09DA06, C09DA07, C09DA08, C09DB02, C09XA02, C09XA52, C10BX03, G04CA03Drug Exclusions:Generic name spironolactoneDrug Identification Numbers (DINs): 00028606, 00180408, 00285455, 00594377, 00613215, 00613223, 00613231, 00657182For more information on prevalence and relative risk of hypertension in adults, see:For more information on prevalence and relative risk of hypertension in children, see:11. Fransoo et al. (2019)In The 2019 RHA Indicators Atlas by Fransoo et al. (2019), they defined hypertension as anyone age 19 and older with:at least one hospital diagnosis for hypertension: (ICD10-CA codes: I10-I13, I15) in one year, OR at least two ambulatory visit diagnoses: (ICD-9-CM codes: 401-405) in one year, ORFor more information about hypertension, see Section 4.1 Hypertension Prevalence and Section 4.2 Hypertension Incidence in the 2019 RHA Indicators Atlas.Calculating Population-based Prevalence RatesRobinson et al. (1997) did not calculate prevalence estimates using their validated algorithms.Lix et al. (2006) calculated crude prevalence estimates for each of the investigated algorithms. These estimates were developed for the period 1995/96 to 2002/03, for the population 19 years of age and older. Only crude prevalence estimates were reported.From Lix et al. (2008), Table 4 reports the crude provincial prevalence estimates for the 28 hypertension algorithms investigated. Discussion of the prevalence rates for hypertension can be found in Chapter 7 of the full report, available through a link from the Lix et al. (2008) reference.CautionsNOTE: Lists of drugs to treat diseases change all the time: new drugs are added, drugs are taken off the market, etc. Also it is very research specific.
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The medication lists presented in this concept represent a starting point to identifying the medications used to treat hypertension. It is always preferable to consult a clinician or pharmacist.