Abstract TAC246: Trends in Untreated Elevated Blood Pressure in Routine Clinical Practice, 2014-2024: a Nationwide Study

Background/Objectives: There has been a major effort by health systems to promote the initiation of treatment of elevated blood pressure; however, there is little longitudinal data on trends in treatment in routine clinical practice. Methods: We used Epic Cosmos, a dataset of Epic health systems representing more than 299 million patients, to perform a retrospective study including patients age >=18 with no antihypertensive treatment in the two years preceding a primary care office visit with elevated blood pressure documented. The percentage of patients who did not receive a prescription for at least one medication recommended by the 2017 ACC/AHA High Blood Pressure guideline at that office visit were calculated across the following criteria: SBP >=160, SBP 140-159, and DBP >=90. Results were stratified by patient age group, race, ethnicity, and sex. Log-linear regression was used to estimate annual percent changes (APC) and interaction terms were fitted for each group to evaluate differences in trends over time. Results: In total, 7,327,224 patients with SBP >160, 30,045,600 patients with SBP 140-159, and 22,263,061 patients with DBP >90 were included in the study. At the SBP >=160 threshold, 67.1% (95% CI 66.9-67.2%) were untreated in 2014, compared to 64.8% (95% CI 64.7-64.9%) in 2024. At the SBP 140-159 threshold, 84.9% (95% CI 84.8-84.9%) were untreated in 2014, compared to 83.1% (95% CI 83.1-83.2%) in 2024. At the DBP >=90 threshold, 80.4% (95% CI 80.4-80.5%) were untreated in 2014 compared to 78.1% (95% CI 78.1-78.2%) in 2024. The magnitude of these declines were modest: APC -0.47% (95% CI -0.65% to -0.30%, p<.001) for SBP >160, APC -0.28%, (95% CI -0.37% to -1.82%, p<.001) for SBP 140-159, and APC -0.39% (95% CI -0.49% to -0.30%, p<.001) for DBP>=90. Female patients were less likely to be treated, and this difference widened over time (Figure 1). White patients were least likely to be treated and Black patients were most likely to be treated (Figure 2). Patients aged 40-50 years were the most likely to be treated, and patients aged 18-30 and 85 years or more were the least likely to be treated (Figure 3). Conclusion: Most patients meeting criteria for initiation of pharmacological treatment of hypertension do not receive such treatment in routine primary care practice. Improvements in treatment of hypertension from 2014-2024 were modest, and differences in treatment across demographic groups raise concerns about equitable treatment of hypertension.