UF-led study: opportunities exist for improving blood pressure control and reducing health disparities

A University of Florida-led study of nearly 2 million Americans found that one in three individuals lack proper blood pressure control, with health disparities contributing to lower control rates among Blacks.

UF researchers, along with colleagues from the University of California San Francisco, Duke University and elsewhere, examined electronic health records from 25 health systems across the United States and found only 62% of patients had their blood pressure managed properly. In Black patients, only 57% had their blood pressure under control. Overall, there was also substantial variation among health systems in blood pressure control rates, ranging from 44% to 74%.

Rhonda Cooper-DeHoff
Rhonda Cooper-DeHoff, Pharm.D., M.S.

“This is the first large-scale, longitudinal electronic health records-based blood pressure control surveillance study that provides a good perspective of what is happening at health systems around the country,” said Rhonda Cooper-DeHoff, Pharm.D., M.S., FAHA, FACC, FCCP, an associate professor in the UF College of Pharmacy and lead author of the study published in the Journal of the American Heart Association. “What we found is that major opportunities exist for improving blood pressure control and reducing disparities.”

An analysis of patient records from January 2017 until the end of 2019 determined that blood pressure control rates remained lower in Black patients than in other racial and ethnic groups. Cooper-DeHoff’s study did not suggest that Blacks were undertreated; instead she said adherence, socioeconomic and health system factors can contribute to health disparities.

Researchers also observed that medication intensification, which is known to be effective in lowering blood pressure, occurred in only 12% of patient visits where blood pressure was uncontrolled. Medication intensification occurs when a prescriber adds another medication that works in a different way to lower blood pressure. When medicine was added, there was a large decrease in blood pressure rates.

“If you are one of the 38% of Americans in our study who are struggling with blood pressure control, then there appears to be a real opportunity for blood pressure improvement,” Cooper-DeHoff said. “If we really want to impact blood pressure rates in the United States, then we need to give practitioners the data to understand how their patients are doing in regard to blood pressure control and when there are opportunities for improvement in the process related to taking care of patients with hypertension.”

According to the Centers for Disease Control and Prevention, about half of all American adults experience hypertension. The American College of Cardiology and the American Heart Association guidelines define high blood pressure as a systolic blood pressure greater than 130 mmHg or a diastolic blood pressure greater than 80 mmHg. UF researchers used these guidelines, along with others published by the National Quality Forum and the Centers for Medicare and Medicaid Services to develop hypertension quality and process metrics, which are described in their study.

Hypertension can contribute to a higher risk of stroke, heart attack, diabetes, heart failure and even death. While high blood pressure is a common chronic condition, there are many medications — including lower-priced generic drugs — to treat it.

“It’s really important that uncontrolled blood pressure is recognized and treated appropriately,” Cooper-DeHoff said. “We have to make blood pressure management a part of every doctor’s visit and educate patients on the importance of taking blood pressure control medications when appropriate.”

The study “Tracking Blood Pressure Control Performance and Process Metrics in 25 U.S. Health Systems: The PCORnet Blood Pressure Control Laboratory,” was published Oct. 7 in the Journal of the American Heart Association. Funding for the research was provided by the Patient-Centered Outcomes Research Institute, the American Medical Association and the American Heart Association.