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Research article:

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. British Journal of General Practice (in press), doi: 10.1101/2023.03.14.23286419

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Background: Hypertension is a key potentially modifiable risk factor for cardiovascular disease-the leading cause of death in the UK. Good blood pressure (BP) control reduces mortality; however, health inequalities may lead to variability in hypertension management. Aim: To investigate health inequities related to ethnicity, sex, age, and socio-economic status in the 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 1st April 2019. Methods: Multivariable logistic regression was used to estimate associations of demographics and treatment intensity on the following hypertension management indicators: 1) BP recording in last 12 months, 2) BP on age-adjusted target, 3) BP on age-adjusted target and BP recorded in last 12 months. Results: In total, 156,296 adults were included. Black/Black British ethnic groups were less likely to have controlled BP than White ethnic groups (OR 0.89, 95% CI = 0.86-0.92). Asian/Asian British ethnic groups were more likely to have controlled blood pressure (OR 1.29, 95% CI = 1.25-1.34). Ethnic differences in control could not be explained by the likelihood of having a recent blood pressure recording, nor by treatment intensity differences. Older adults were more likely to have controlled hypertension than younger patients. Conclusion: 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.
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John Robson
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Res200: HYP_RES_CODES Download this codelist
Res200: HYP_CODES Download this codelist

1 comment has been posted.

Feb. 3, 2023, 7:42 a.m. - Stuart Rison

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".

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