Ps-p03-2: racial and ethnic disparities in hypertension control in an integrated healthcare system in the united states, 2008–2019

Objective: To determine whether racial/ethnic disparities in control of hypertension changed from 2008 through 2019 within a large and diverse integrated healthcare system that implemented a series of health care delivery changes in 2011 to address disparities in hypertension control. Design and method: We evaluated hypertension control, defined as systolic BP < 140 mmHg and diastolic BP < 90 mmHg, among adults age 18 years and older with diagnosed hypertension identified from a clinical hypertension registry, stratified by race/ethnicity (self-reported as non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic, or Asian or Pacific Islander (API)) from 2008–2019. Results: Between 2008 and 2019, the population with hypertension increased from 624,094 to 855,257. Mean age was 61.8 years in 2008 and increased to 64.5 years in 2019; ∼52% of the population in each year was female. The proportion of NHW and NHB adults decreased during this period from 45.4% to 38.8% and 14.3% to 12.5%, respectively, while the proportion of API and Hispanic adults increased from 9.8% to 12.6% and 25.2% to 33.0%, respectively. The overall age-adjusted estimated proportion with controlled hypertension increased from 2008 to 2013 from 74.3% (95% CI, 74.1%-74.6%) to 83.0% (95% CI, 82.8%-83.2%) and then decreased from 2014 to 2019 from 81.1% (95% CI, 80.9%-81.3%) to 79.3% (95% CI, 79.1%-79.4%). This trend was present in men and women across all races/ethnicities (Figure). In each year, API adults had the highest and NHB adults had the lowest age-adjusted estimated proportion with controlled hypertension. The disparity in controlled hypertension between NHW and NHB women was 5.7% (p < .001) in 2008 and decreased to 1.6% (p < .001) in 2015 and increased to 2.7% (p < .001) by 2019. In 2008, the disparity in controlled hypertension between NHW and NHB men was 7.1% (p < .001) and decreased to 2.8% (p < .001) in 2016 and increased to 3.7% (p < .001) by 2019. In 2019, NHB adults were more likely to have uncontrolled hypertension compared with NHW adults (multivariable-adjusted prevalence ratio, 1.13 [95% CI, 1.12–1.14]). Conclusions: While disparities in hypertension control have narrowed between NHB and NHW adults in this integrated healthcare system, differences persist. Understanding these differences can help identify continued unmet needs and guide more equitable health care to reduce the burden of hypertension-related cardiovascular disease.