Comparing the Documentation of Phosphatidylethanol and Alcohol History in Hypertension Management in Primary Care: A Cross-Sectional Study
Anders Norrman, Åsa Thurfjell, Maria Hagströmer, Johanna Adami, Lena Lundh, Jan HasselströmIntroduction/Objectives
Hazardous alcohol use is a modifiable risk factor for hypertension, yet it is often underrecognized in primary care, and the role of Phosphatidylethanol (PEth) testing in documenting alcohol use remains unclear. This study assessed alcohol use documentation using PEth and alcohol history in relation to blood pressure (BP) control and patient characteristics, and examined hazardous alcohol use by both methods in relation to BP control.
Methods
All patients with hypertension from a Swedish primary care centre, routinely using PEth, were included in a cross-sectional study based on electronic medical records. Patients were categorized as having controlled (<140/90 mmHg), uncontrolled (≥140/90 mmHg), or apparent treatment-resistant hypertension (aTRH) (≥140/90 mmHg despite ≥3 antihypertensive drugs). Alcohol documentation and hazardous use were analyzed using PEth 16:0/18:1 values and alcohol history (free-text entries or AUDIT). Group differences were examined using chi-square and one-way ANOVA.
Results
A total of 1,826 patients were included (mean age 71 years; 51.5% women); 35% had controlled hypertension, 50% uncontrolled hypertension, and 16% aTRH. Documentation patterns differed by BP control, sex, age, and comorbidities. PEth was documented more often than alcohol history (56.0% vs. 39.9%, respectively). Women, older individuals, and patients with diabetes more frequently lacked documentation. Hazardous alcohol use was identified in 18.4% using PEth and 7.1% using alcohol history, with no differences across BP control groups. Hazardous use was higher in men by PEth, not alcohol history.
Conclusion
PEth testing can complement alcohol history in hypertension management, providing clinically relevant information, although its impact on detecting hazardous drinking or improving BP control remains uncertain.