Latino-White Disparities in Identification and Control of Elevated Blood Pressure Among Adults With Hypertension

Abstract

Background: Studies analyzing blood pressure (BP) management using the hypertension control cascade have consistently shown disparities in hypertension awareness, treatment, and BP control between Latino patients and non-Latino White patients. We analyze this cascade using electronic health record data from a multistate network of community health centers.

Methods and results: Data from 790 clinics in 23 US states from 2012 to 2020, including 1 270 174 patients, were analyzed to compare BP documentation in the electronic health record, clinician acknowledgment (diagnosis or treatment) of incident hypertension (BP ≥140/90), medication prescription, and BP control between non-Latino White patients, English-preferring Latino patients, and Spanish-preferring Latino patients, adjusted for patient-level covariates, and clustered on patients' primary clinics. Among the 429 182 patients with elevated BP (≥140/90) during ambulatory visits from 2012 to 2020, we found that clinician acknowledgment of hypertension was more likely in Spanish-preferring and English-preferring Latino patients versus non-Latino White patients (adjusted odds ratio [aOR], 1.17 [95% CI, 1.11-1.24]; aOR, 1.07 [95% CI, 1.02-1.12], respectively). In addition, Spanish-preferring Latino patients were more likely to receive a medication versus non-Latino White patients (aOR, 1.21 [95% CI, 1.16-1.28]). Among those receiving medication, Latino patients were as likely as non-Latino White patients to have their BP controlled (<140/90).

Conclusions: In a large retrospective study of community health center patients with incident hypertension, the expected disparities in hypertension management between Spanish-preferring Latino, English-preferring Latino, and non-Latino White patients were not identified. These findings add to the hypertension control cascade by examining robust electronic health record data from community health centers and may provide clues to reducing disparities in hypertension management.

Keywords: blood pressure; community health centers; disparities; hypertension control cascade.

Figure 1. Forest plot of odds ratios.

For the outcomes of HTN acknowledgment and HTN‐related RX, we restricted the analysis to patients with ≥2 high BP measurements at AVs, or ≥1 high AV BP with subsequent acknowledgment or HTN‐related RX before the second high AV BP (n=193 482). For the outcome of controlled BP, we restricted further to patients with HTN‐related RX and at least 1 AV BP measured in the postperiod (20–180 days after RX before March 1, 2020; n=89 328). All adjusted generalized estimating equation logistic regression models include age, sex, income, insurance coverage, existing comorbidities (heart disease, heart failure, cerebrovascular disease, peripheral vascular disease, kidney disease, diabetes), body mass index, region of primary care facility, and rate of primary care facility visits. Acknowledgment and RX models were additionally adjusted for the number of additional elevated BPs while at risk. The controlled BP model adjusted for the preperiod mean systolic and diastolic BP and the timing of the postperiod BPs (as number of days past the prescription date). AV indicates ambulatory visit; BP, blood pressure; HTN, hypertension; and RX, prescription.