Hypertension Trends and Disparities Over 12 Years in a Large Health System: Leveraging the Electronic Health Records

• Published in: Journal of the American Heart Association 2024-05, Vol.13 (9), p.e033253-e033253
• Main Authors: Brush, Jr, John E, Lu, Yuan, Liu, Yuntian, Asher, Jordan R, Li, Shu-Xia, Sawano, Mitsuaki, Young, Patrick, Schulz, Wade L, Anderson, Mark, Burrows, John S, Krumholz, Harlan M
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antihypertensive Agents - therapeutic use; Blood Pressure - drug effects; Blood Pressure Determination - methods; Cross-Sectional Studies; Electronic Health Records; Female; Health Status Disparities; health systems; Healthcare Disparities - trends; Humans; Hypertension - diagnosis; Hypertension - drug therapy; Hypertension - epidemiology; hypertension prevalence; Male; Middle Aged; Original Research; Prevalence; racial disparities; real‐world data; Time Factors
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.123.033253

The digital transformation of medical data enables health systems to leverage real-world data from electronic health records to gain actionable insights for improving hypertension care. We performed a serial cross-sectional analysis of outpatients of a large regional health system from 2010 to 2021. Hypertension was defined by systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, or recorded treatment with antihypertension medications. We evaluated 4 methods of using blood pressure measurements in the electronic health record to define hypertension. The primary outcomes were age-adjusted prevalence rates and age-adjusted control rates. Hypertension prevalence varied depending on the definition used, ranging from 36.5% to 50.9% initially and increasing over time by ≈5%, regardless of the definition used. Control rates ranged from 61.2% to 71.3% initially, increased during 2018 to 2019, and decreased during 2020 to 2021. The proportion of patients with a hypertension diagnosis ranged from 45.5% to 60.2% initially and improved during the study period. Non-Hispanic Black patients represented 25% of our regional population and consistently had higher prevalence rates, higher mean systolic and diastolic blood pressure, and lower control rates compared with other racial and ethnic groups. In a large regional health system, we leveraged the electronic health record to provide real-world insights. The findings largely reflected national trends but showed distinctive regional demographics and findings, with prevalence increasing, one-quarter of the patients not controlled, and marked disparities. This approach could be emulated by regional health systems seeking to improve hypertension care.