Evaluation of guideline adherence to hypertension-mediated organ damage screening in Korean patients with hypertension: results from the Korean Registry of Target Organ Damage in Hypertension (KorHR)

Background: Adherence to guidelines for hypertension-mediated organ damage (HMOD) assessment has not been extensively studied. We aimed to evaluate guideline adherence to HMOD assessment and to identify factors associated with this adherence. Methods: In this prospective, multicenter observational study conducted from May 2013 to December 2022, we evaluated adherence to guideline-recommended HMOD screening among 2,070 hypertensive patients enrolled from 24 tertiary care centers in Korea. Patients were categorized as either newly treated or on treatment. The basic screening tests included urine albumin-to-creatinine ratio (UACR), electrocardiography (ECG), and glomerular filtration rate (GFR). The extended screening tests included echocardiography, carotid ultrasonography, fundoscopic examination, ankle-brachial index measurement, and brachial-ankle pulse wave velocity assessment. Results: The overall adherence rate for basic screening was 68.4%. Compliance with GFR and ECG assessments was high (90.3% and 95.2%, respectively), whereas adherence to UACR testing was lower (72.5%). The adherence rate for basic screening was significantly lower in the on-treatment group compared with the newly treated group (57.1% vs. 79.9%). Elderly patients (≥ 60 years) exhibited the lowest adherence to basic screening. Further analyses revealed that increasing age was significantly associated with a lower likelihood of completing both basic and extended screenings. Conclusions: Guideline-recommended HMOD screening remains underutilized in routine clinical practice, particularly among elderly patients. These findings underscore the need to improve adherence to HMOD screening. Trial Registration: ClinicalTrials.gov Identifier: NCT01861080.