Changes in Rates of Uncontrolled Hypertension Among Federally Qualified Health Center Patients, 2019 to 2022: State-Level Group-Based Trajectory Modeling Analysis

BACKGROUND: The COVID-19 pandemic disrupted primary care and chronic disease management in the U.S., potentially affecting hypertension control differently across populations, particularly in patients with limited healthcare access. This study examined state-level patterns in uncontrolled hypertension among Federally Qualified Health Center (FQHC) patients during and after the pandemic. METHODS: Using 2019 to 2022 Uniform Data System data, we analyzed state-level trends in uncontrolled hypertension rates among FQHC patients. Group-based trajectory modeling was applied to identify patterns across states for all patients and separately by race and ethnicity. We examined associations between trajectory groups and state-level COVID-19 mortality rates. RESULTS: Four trajectory groups emerged for all races combined; the least favorable group (Group 4) included 5 states with consistently high uncontrolled hypertension rates. Among non-Hispanic Black patients, 24 states fell into the least favorable trajectory group. Most trajectory groups demonstrated recovery toward pre-pandemic levels by 2022, with mortality rates declining to 48.7 to 78.4 per 100,000 across groups. CONCLUSIONS: Although hypertension control largely rebounded to pre-pandemic levels by 2022, differences persisted across geographic and racial groups. Patients living in states with the least favorable trends may benefit from targeted strategies to enhance hypertension management. These findings highlight the critical need to sustain chronic disease care during public health crises and to address health outcomes driven by structural factors.