{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T19:21:58Z","timestamp":1754162518751,"version":"3.41.2"},"reference-count":30,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T00:00:00Z","timestamp":1750636800000},"content-version":"vor","delay-in-days":22,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Clinical Hypertension"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:label\/><jats:p>High blood pressure (BP) is a frequent cause for visits to primary healthcare centers (PHCCs) in Sweden. Guidelines on methods for BP measurements for diagnosis of hypertension have recently been updated. We aimed to study adherence to diagnostic guidelines in hypertension management and evaluate whether adherence to guidelines was related to organizational or sociodemographic characteristics. Interviews with representatives from 76 randomly selected PHCCs from eight regions in Sweden were conducted. PHCCs\u2019 use of 24\u2010h ambulatory BP monitoring (ABPM), home BP monitoring (HBPM) and BP measurements in both arms for the diagnosis of hypertension were chosen as proxy markers for adherence to diagnostic guidelines. An adherence index was created as a composite score of these diagnostic methods. The proportion of PHCCs stating they \u201coften use\u201d ABPM and HBPM were 13.7% and 16.0%, respectively, and 57.3% stated they performed BP measurements in both arms. Two PHCCs did not use ABPM, HBPM or BP measurements in both arms to diagnose hypertension. None of the organizational or sociodemographic characteristics (number of listed patients, Care Need Index (CNI), geographical location, ownership, investigation primarily led by doctor\/nurse, dedicated team management, special training for hypertension and local routines) were associated with the adherence index. This study shows that adherence to diagnostic guidelines vary largely between PHCCs. No organizational characteristic, not even team\u2010based management, was associated with adherence to diagnostic guidelines. The variation raises questions about inequity healthcare and novel strategies that may be needed to improve PHCCs\u2019 adherence to diagnostic guidelines in hypertension management. Trial Registration: ClinicalTrials.gov identifier: 263351 [www.researchweb.org]<\/jats:p><\/jats:sec>","DOI":"10.1111\/jch.70079","type":"journal-article","created":{"date-parts":[[2025,6,24]],"date-time":"2025-06-24T02:48:46Z","timestamp":1750733326000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Large Variation in Adherence to Diagnostic Guidelines in Hypertension Management in Swedish Primary Healthcare"],"prefix":"10.1111","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5257-6261","authenticated-orcid":false,"given":"Mikko","family":"Hellgren","sequence":"first","affiliation":[{"name":"University Health Care Research Centre, \u00d6rebro University Hospital  \u00d6rebro Sweden"},{"name":"School of Medical Sciences \u00d6rebro University  \u00d6rebro Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristina Bengtsson","family":"Bostr\u00f6m","sequence":"additional","affiliation":[{"name":"School of Public Health and Community Medicine Institute of Medicine, Sahlgrenska Academy, University of Gothenburg  G\u00f6teborg Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katarina","family":"Hedin","sequence":"additional","affiliation":[{"name":"Futurum Region J\u00f6nk\u00f6ping County  J\u00f6nk\u00f6ping Sweden"},{"name":"Department of Health Medicine and Caring Sciences, Link\u00f6ping University  Link\u00f6ping Sweden"},{"name":"Department of Clinical Sciences in Malm\u00f6 Family Medicine, Lund University  Malm\u00f6 Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefan","family":"Jansson","sequence":"additional","affiliation":[{"name":"University Health Care Research Centre, \u00d6rebro University Hospital  \u00d6rebro Sweden"},{"name":"School of Medical Sciences \u00d6rebro University  \u00d6rebro Sweden"},{"name":"Department of Public Health and Caring Sciences Uppsala University  Uppsala Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Staffan","family":"Nilsson","sequence":"additional","affiliation":[{"name":"Department of Health Medicine and Caring Sciences, Link\u00f6ping University  Link\u00f6ping Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gunnar","family":"Nilsson","sequence":"additional","affiliation":[{"name":"Department of Public Health and Clinical Medicine Family Medicine, Ume\u00e5 University  Ume\u00e5 Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5169-2965","authenticated-orcid":false,"given":"Per","family":"W\u00e4ndell","sequence":"additional","affiliation":[{"name":"Division of Family Medicine and Primary Care Department of Neurobiology Care Sciences and Society, Karolinska Institutet  Huddinge Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrik","family":"Wennberg","sequence":"additional","affiliation":[{"name":"Department of Public Health and Clinical Medicine Family Medicine, Ume\u00e5 University  Ume\u00e5 Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,6,23]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurjpc\/zwab087"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471\u20102458\u201013\u2010670"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(20)30752\u20102"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.184182"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12875\u2010017\u20100672\u20107"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.3109\/02813432.2012.684207"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/cvr\/cvac130"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0124769"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.116.309115"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/HJH.0000000000001961"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/HJH.0000000000003480"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/jch.14909"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/jch.14798"},{"key":"e_1_2_12_15_1","unstructured":"Swedish Agency for Health and Care Services Analysis Nationell uppf\u00f6ljning av h\u00e4lso\u2010 och sjukv\u00e5rden 2022. 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