Inequities in hypertension management: an observational cross-sectional study in North-East London using electronic health records
Rison, S., Redfern, O., Dostall, I., Carvalho, C., Mathuri, R., Raisi -Estabrag, Z., Robson, J.(2023)
Inequities in hypertension management: an observational cross-sectional study in North-East London using electronic health records.
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Cardiovascular disease remains the leading cause of death in the UK and hypertension is a key potentially modifiable factor. Good control of blood pressure reduces mortality but variability in hypertension management may contribute to inequalities in blood pressure control.
To investigate health inequities related to ethnicity, sex, age and socio-economic status in the treatment and control of blood pressure in a large cohort of adult patients with hypertension.
Design and Setting
A cross-sectional cohort study of adults with hypertension currently registered with 190 of the 199 practices in the North-East London region on 1st April 2019.
Three indicators of hypertension management were derived, and multivariate logistic regression was used to identify the influence of demographic and treatment intensity on the likelihood of individuals having controlled hypertension.
In total, 156,296 adults were included. People of Black/Black British ethnicity were less likely to have controlled blood pressure than White patients (OR 0.89, 95% CI = 0.86 to 0.92). Conversely, Asian/Asian British individuals were more likely to have controlled blood pressure (OR 1.29, 95% CI = 1.25 to 1.34). This was not a reflection of their likelihood of having a recent blood pressure recording, nor could it be explained by treatment intensity differences. Older adults were more likely to have controlled hypertension than younger patients.
Black/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.
- Author for correspondence
- John Robson
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Cohort patients where extracted from EMIS WEB using GP practices using Read codes indicated in Code list "HYP_CODES". The EMIS-generated equivalent SNOMED codes are give in the same codelist (coding_system = 'SNOMED'). Patient with a valid "Hypertension resolved" Read code more recent than any HYP_CODE were excluded. The "Hypertension resolved" Read and the EMIS-generated equivalent SNOMED code are in Code list "HYP_RES_CODES".