Undiagnosed and uncontrolled hypertension at a federally qualified health center

Hypertension is a preventable risk factor for cardiovascular disease and mortality yet is often undiagnosed and uncontrolled. Federally Qualified Health Centers (FQHC) serve vulnerable, understudied populations having characteristics that are associated with greater risk for undiagnosed and uncontrolled hypertension. This study aimed to determine the burden and risk factors associated with undiagnosed and uncontrolled hypertension at a large FQHC, with the co-primary outcomes of yearly rates of undiagnosed and uncontrolled hypertension. The design was a retrospective cross-sectional study of adult patients seen at an FQHC between 2019-2023. Undiagnosed hypertension was defined as an elevated average blood pressure reading ( ≥ 130/80) over at least two encounters within the same year. Hypertension was defined according to the 2025 ACC/AHA guidelines, ≥130/80. Crude and age-adjusted rates for the co-primary outcomes were calculated and adjusted mixed-effects logistic regression identified risk factors. From 2019 to 2023, the yearly percent of age-adjusted undiagnosed hypertension ranged from 28.7-34.7%. From 2019 to 2023, the yearly burden of age-adjusted uncontrolled hypertension ranged from 74.0-79.5%, irrespective of treatment. Factors associated with higher rates of undiagnosed hypertension included older age (OR 1.04, 95% CI [1.04, 1.04]), male sex (2.9, [2.7, 3.2]) and Black race (1.3, [1.1, 1.4]). Factors associated with higher rates of uncontrolled hypertension included male sex (OR 1.2, 95% CI [1.1, 1.2]), Black race (1.5, [1.4, 1.7]), other language preference (1.3, [1.1, 1.4]), and self-pay insurance (1.2, [1.1, 1.4]). There was a substantial burden of undiagnosed and uncontrolled hypertension with intervention needed to reduce cardiovascular disease.