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Inequities in hypertension management: observational cross-sectional study in North East London using electronic
Stuart Rison1, Oliver Redfern2, Isabel Dostal3
1Clinical Effectiveness Group, Centre for Primary Care, Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London; North East London Integrated Care System, Unex Tower, London.
Insights
Black and younger adults with hypertension have poorer blood pressure control, highlighting potential health inequities. Targeted interventions are needed to improve hypertension management in these groups.
Area of Science:
- Cardiovascular Health
- Public Health
- Health Equity
Background:
- Hypertension is a major modifiable risk factor for cardiovascular disease, the leading cause of death in the UK.
- Effective blood pressure (BP) control is crucial for reducing mortality.
- Health inequities may contribute to disparities in hypertension monitoring and control.
Purpose of the Study:
- To investigate health inequities in hypertension management based on ethnicity, sex, age, and socioeconomic status.
- To examine variations in BP monitoring, treatment, and control among adult hypertensive patients.
- To identify demographic factors associated with suboptimal hypertension care.
Main Methods:
- A cross-sectional cohort study was conducted using data from adult patients with hypertension in North East London.
- Multivariable logistic regression analyzed associations between demographics, treatment intensity, and hypertension management indicators.
- Indicators included recent BP recording, BP control on age-adjusted targets, and combined control and recording.
Main Results:
- The study included 156,296 adult patients with hypertension.
- Black ethnicity was associated with lower odds of controlled BP compared to White ethnicity (OR 0.87).
- Asian ethnicity showed higher odds of controlled BP (OR 1.28), and older adults (≥50 years) had better BP control than younger patients.
Conclusions:
- Individuals of Black ethnicity and younger patients are less likely to achieve controlled hypertension.
- These findings suggest a need for targeted interventions to address disparities in hypertension management.
- Further research is required to understand the underlying reasons for observed ethnic differences in BP control.
Background:
Hypertension is a key modifiable risk factor for cardiovascular disease - the leading cause of death in the UK. Good blood pressure (BP) control reduces mortality. However, health inequities may lead to variability in hypertension monitoring and control.
Aim:
To investigate health inequities related to ethnicity, sex, age, and socioeconomic status in the monitoring, treatment, and control of BP in a large cohort of adult patients with hypertension.
Design And Setting:
A cross-sectional cohort study of adults with hypertension registered with general practices in North East London on 1 April 2019.
Method:
Multivariable logistic regression was used to estimate associations of demographics and treatment intensity for the following hypertension management indicators: a) BP recording in past 12 months; b) BP on age- adjusted target; and c) BP on age-adjusted target and BP recorded in past 12 months.
Results:
In total, 156 296 adults were included. The Black ethnicity group was less likely to have controlled BP than the White ethnicity group (odds ratio [OR] 0.87, 95% [confidence interval] CI = 0.84 to 0.91). The Asian ethnicity group was more likely to have controlled BP (OR 1.28, 95% CI = 1.23 to 1.32). Ethnicity differences in control could not be explained by the likelihood of having a recent BP recording, nor by treatment intensity differences. Older adults (aged ≥50 years) were more likely to have controlled hypertension than younger patients.
Conclusion:
Individuals of Black ethnicity and younger people are less likely to have controlled hypertension and may warrant targeted interventions. Possible explanations for these findings are presented but further research is needed about reasons for ethnic differences.
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