Inequities in hypertension management: an observational cross-sectional study in North-East London using electronic health records

Abstract

ABSTRACTBackgroundHypertension is a key potentially modifiable risk factor for cardiovascular disease-the leading cause of death in the UK. Good blood pressure (BP) control reduces mortality; however, health inequalities may lead to variability in hypertension management.AimTo investigate health inequities related to ethnicity, sex, age, and socio-economic status in the treatment and control of BP in a large cohort of adult patients with hypertension.Design and SettingA cross-sectional cohort study of adults with hypertension registered with general practices in North East London on 1stApril 2019.MethodMultivariable logistic regression was used to estimate associations of demographics and treatment intensity on the following hypertension management indicators: 1) BP recording in last 12 months, 2) BP on age-adjusted target, 3) BP on age-adjusted target and BP recorded in last 12 months.ResultsIn total, 156,296 adults were included. Black/Black British ethnic groups were less likely to have controlled BP than White ethnic groups (OR 0.89, 95% CI = 0.86-0.92). Asian/Asian British ethnic groups were more likely to have controlled blood pressure (OR 1.29, 95% CI = 1.25-1.34). Ethnic differences in control could not be explained by the likelihood of having a recent blood pressure recording, nor by treatment intensity differences. Older adults were more likely to have controlled hypertension than younger patients.ConclusionBlack/Black British and younger people are less likely to have controlled hypertension and may warrant targeted interventions. Possible explanations for these findings are presented and further research is needed on reasons for ethnic differences.HOW THIS FITS INHealth inequities in the management of long-term conditions are widely recognised. This study identifies ethnic, age, gender and deprivation inequities in the control of blood pressure in a large unselected cohort of adults with hypertension in an ethnically diverse and nationally disadvantaged area of London. It confirms previous findings that blood pressure control in Black ethnic groups with hypertension is worse than in White or Asian ethnic groups. These differences were not related to access to blood pressure recording or treatment intensity. Younger adults were less likely to have controlled hypertension than older adults.