Hypertension Trends And Disparities Over Twelve Years In A Large Health System: Leveraging The Electronic Health Records

Background: The digital transformation of medical data enables health systems to leverage real-world data (RWD) from electronic health records (EHR) to gain actionable insights for improving hypertension care. Methods: 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 (SBP) >/= 140 mmHg or diastolic blood pressure (DBP) >/= 90 mmHg) or recorded treatment with anti-hypertension medications. We evaluated four methods of using blood pressure measurements in the EHR to define hypertension. The primary outcomes were age-adjusted prevalence rates and age-adjusted control rates. Secondary outcomes were age-adjusted mean SBP and DBP and age-adjusted proportion of patients with a searchable diagnosis code of hypertension in the EHR. Results: Hypertension prevalence varied depending on the definition used, ranging from 36.5% to 50.9% initially and increasing over time by approximately 5%, regardless of the definition used. Control rates ranged from 61.2% to 71.3% initially, rose during 2018-2019 and fell during 2020-2021. 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 SBP and DBP and lower control rates compared with other racial and ethnic groups. Conclusion: In a large regional health system, we leveraged the EHR to provide real-world insights. The findings largely reflected national trends but showed distinctive regional demographics and findings. The findings have provided opportunities for improvement, with prevalence increasing, a quarter of the patients not controlled, and marked disparities. This approach could be emulated by regional health systems seeking to improve hypertension care. ### Competing Interest Statement In the past three years, Dr. Krumholz received expenses and/or personal fees from UnitedHealth, Element Science, Aetna, Reality Labs, Tesseract/4Catalyst, F-Prime, the Siegfried and Jensen Law Firm, Arnold and Porter Law Firm, and Martin/Baughman Law Firm. He is a co-founder of Refactor Health and HugoHealth, and is associated with contracts, through Yale New Haven Hospital, from the Centers for Medicare & Medicaid Services and through Yale University from Johnson & Johnson. Dr. Brush receives royalties from Dementi Milestone Publishing for the book ?The Science of the Art of Medicine: A Guide to Medical Reasoning.? Dr. Schulz received expenses and/or personal fees from HugoHealth, Abbott, Instrumentation Laboratories, and Detect, Inc., and is a cofounder of Refactor Health. The other authors report no disclosures. ### Funding Statement Batten Foundation ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Approved by the IRB of Eastern Virginia Medical School I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The primary data is protected health information and cannot be made available.