Key result
Among 213,836 adults, 29.7% had uncontrolled hypertension, 13.1% had a hypertensive crisis, and 5.9% had persistently uncontrolled hypertension, with higher risk in Black and self-pay patients.
Why the study?
Uncontrolled hypertension significantly increases the risk of cardiovascular disease and death, motivating an examination of uncontrolled hypertension, persistently uncontrolled hypertension, and hypertensive crisis in real-world patients.
Cohort (n=213,836)
A significant proportion of patients in a large healthcare system have uncontrolled hypertension or hypertensive crises, with higher risk among vulnerable populations such as Black and uninsured patients.
Observational prevalence data underscore real-world control gaps; leaves open targeted intervention trials before practice change.
BACKGROUND: Uncontrolled hypertension significantly increases risk of cardiovascular disease and death. This study examined the prevalence of uncontrolled hypertension, persistently uncontrolled hypertension, and hypertensive crisis and factors associated with these outcomes in a real-world patient cohort. METHODS: Electronic medical records from a large healthcare system in North Carolina were used to identify adults with uncontrolled hypertension (last ambulatory blood pressure [BP] measurement ≥140/90); persistently uncontrolled hypertension (≥2 ambulatory BP measurements with all readings ≥140/90); and hypertensive crisis (any BP reading ≥180/120) in 2019. Generalized linear mixed models tested the association between patient and provider characteristics and each outcome. RESULTS: The study cohort included 213,836 patients (mean age 63.1 (±14.0) years, 55.5% female, 70.8% white). Of these, 29.7% and 13.1% had uncontrolled hypertension and hypertensive crisis, respectively. Among those experiencing hypertensive crisis, >50% did not have uncontrolled hypertension. Of the 171,061 patients with ≥2 BP measurements, 5.9% had persistently uncontrolled hypertension. The likelihood of uncontrolled hypertension, persistently uncontrolled hypertension, and hypertensive crisis was higher in patients with black race (vs. white), self-pay (vs. private), prior emergency room visit, and no attributed primary care provider. Readings taken in the evening (vs. morning) and at specialty (vs. primary care) practices were more likely to meet thresholds for uncontrolled hypertension and hypertensive crisis. CONCLUSIONS: Hypertension control remains a significant challenge in healthcare. Health systems may benefit from segmenting their patient population based on factors such as race, prior healthcare use, and timing of BP measurement to prioritize outreach and intervention.
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Mahabaleshwarkar et al. (2023) conducted a cohort in Hypertension (n=213,836). Patient and provider characteristics (e.g., black race, self-pay) vs. Reference groups (e.g., white race, private insurance) was evaluated on Uncontrolled hypertension. Among 213,836 adults, 29.7% had uncontrolled hypertension, 13.1% had a hypertensive crisis, and 5.9% had persistently uncontrolled hypertension, with higher risk in Black and self-pay patients.
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