Follow-Up of Elevated Blood Pressure in Swedish Primary Care: An Analysis of Electronic Health Records From 111,986 Patients

Objective: Current guidelines recommend multiple measurements to diagnose hypertension due to high blood pressure variability. However, follow-up rates and socioeconomic disparities in this process remain under-researched. In order to clarify gaps in care and potential disparities, we assessed the proportion of patients receiving any kind of follow-up after an initial elevated reading and analyzed associations with socioeconomic characteristics. Design and method: We analyzed electronic health records from public primary care centers from one Swedish county (2015–2023). We included patients with elevated office blood pressure and no prior hypertension diagnosis or treatment. Follow-up was defined as a repeated measurement or diagnosis within three months. Data were linked to the Swedish population and healthcare registries. Logistic regression estimated odds ratios (OR) for receiving follow-up procedure. Results: Among 111,986 patients with elevated baseline blood pressure, 63,769 (57%) received no follow-up within three months (including 39,333 patients who did not visit primary care during the follow-up period). Factors associated with increased odds of follow-up included older age (OR = 1.009 per year; 95% CI, 1.008–1.010), higher baseline systolic blood pressure (OR = 1.67 per 10-mmHg increase; 95% CI, 1.65–1.69) and higher diastolic blood pressure (OR = 1.49 per 10-mmHg increase; 95% CI, 1.47–1.51) Compared to males, females were more likely to receive follow-up (OR=1.06; 95% CI 1.03–1.08). Patients born outside Europe had significantly higher odds of follow-up (OR = 1.35; 95% CI, 1.30–1.39) compared to those born in Sweden. However, in a sub-analysis of patients who returned to primary care for any reason (N=72,053), the association for females reversed (OR=0.95; 95% CI 0.92–0.99). This suggested that gender disparities in follow-up are driven by clinic return rates rather than clinical inertia during subsequent visits. Conclusions: Follow-up for elevated blood pressure is suboptimal. Significant disparities based on sex and country of birth highlight a need for targeted strategies to ensure equitable hypertension management and to encourage patient return for follow-up.