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. Key Points Question: Can a large regional health system leverage the electronic health record to analyze hypertension trends and disparities to drive improvement? Findings: We analyzed 1,376,325 patients over 12 years and found that age-adjusted hypertension prevalence increased by approximately 5%. Age-adjusted hypertension control rates were in the 70% range and remained stable. Non-Hispanic Black patients represented 25% of our specific regional population and had 12-14% higher hypertension prevalence rates, higher mean age-adjusted systolic and diastolic blood pressure, and lower hypertension control rates compared with other racial groups. Meaning: Real world data can provide actionable insights about hypertension and disparities in a specific region that could inform regional system strategies and initiatives for improvement.