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Research article:

Inequities in hypertension management: an observational cross-sectional study in North-East London using electronic health records

Reference:

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

Link to article
Abstract
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.
Author for correspondence
John Robson
Email for correspondence
j.robson@qmul.ac.uk

Code list: res200: HYP_CODES

93 codes in list

Code Coding system Description Entity type List name associated_Read_code
G2 Read Hypertensive disease diagnostic res200: HYP_CODES
G2_ Read Hypertensive disease diagnostic res200: HYP_CODES N/A
G20 Read Essential hypertension diagnostic res200: HYP_CODES
G20.. Read Essential hypertension diagnostic res200: HYP_CODES N/A
G24 Read Secondary hypertension diagnostic res200: HYP_CODES
G24.. (excl. G24z1) Read Secondary hypertension diagnostic res200: HYP_CODES N/A
G25 Read Stage 1 hypertension (NICE - Nat Ins for Hth Clin Excl 2011) diagnostic res200: HYP_CODES
G25.. Read Stage 1 hypertension (NICE - Nat Ins for Hth Clin Excl 2011) diagnostic res200: HYP_CODES N/A
G26 Read Severe hypertension (Nat Inst for Health Clinical Ex 2011) diagnostic res200: HYP_CODES N/A
G28 Read Stage 2 hypertension (NICE - Nat Ins for Hth Clin Excl 2011) diagnostic res200: HYP_CODES N/A
G2y Read Other specified hypertensive disease diagnostic res200: HYP_CODES
G2y.. Read Other specified hypertensive disease diagnostic res200: HYP_CODES N/A
G2z Read Hypertensive disease NOS diagnostic res200: HYP_CODES N/A
Gyu2 Read [X]Hypertensive diseases diagnostic res200: HYP_CODES
Gyu2.. Read [X]Hypertensive diseases diagnostic res200: HYP_CODES N/A
10441000006116 SNOMED Other specified hypertensive disease diagnostic res200: HYP_CODES
1201005 SNOMED Benign essential hypertension diagnostic res200: HYP_CODES G20..
1215744012 SNOMED Hypertensive disorder diagnostic res200: HYP_CODES
121910014 SNOMED Benign secondary renovascular hypertension diagnostic res200: HYP_CODES
131046010 SNOMED Malignant essential hypertension diagnostic res200: HYP_CODES
147988014 SNOMED Malignant secondary hypertension diagnostic res200: HYP_CODES
151171000006110 SNOMED Secondary malignant hypertension NOS diagnostic res200: HYP_CODES
1806071000006102 SNOMED Stage 1 hypertension diagnostic res200: HYP_CODES G2y..
1806071000006118 SNOMED Stage 1 hypertension diagnostic res200: HYP_CODES
1806081000006104 SNOMED Stage 2 hypertension diagnostic res200: HYP_CODES G2y..
1806081000006115 SNOMED Stage 2 hypertension diagnostic res200: HYP_CODES
1806141000006109 SNOMED Severe hypertension diagnostic res200: HYP_CODES G2y..
1806141000006113 SNOMED Severe hypertension diagnostic res200: HYP_CODES
194783001 SNOMED Secondary malignant renovascular hypertension diagnostic res200: HYP_CODES G24..
194785008 SNOMED Secondary benign hypertension diagnostic res200: HYP_CODES G24..
194788005 SNOMED Hypertension secondary to endocrine disorders diagnostic res200: HYP_CODES G24..
196353013 SNOMED Elevated blood pressure diagnostic res200: HYP_CODES
196354019 SNOMED Finding of increased blood pressure diagnostic res200: HYP_CODES
2164904016 SNOMED HTN - Hypertension diagnostic res200: HYP_CODES
2189411000000111 SNOMED Stage 1 hypertension (NICE - National Institute for Health and Clinical Excellence 2011) diagnostic res200: HYP_CODES
2189451000000110 SNOMED Severe hypertension (NICE - National Institute for Health and Clinical Excellence 2011) diagnostic res200: HYP_CODES
2193021000000110 SNOMED Severe hypertension diagnostic res200: HYP_CODES
2193031000000112 SNOMED Stage 1 hypertension diagnostic res200: HYP_CODES
2194941000000119 SNOMED Stage 2 hypertension (NICE - National Institute for Health and Clinical Excellence 2011) diagnostic res200: HYP_CODES
2211211000000110 SNOMED Stage 2 hypertension diagnostic res200: HYP_CODES
2335761000000116 SNOMED Stage 1 hypertension (NICE 2011) without evidence of end organ damage diagnostic res200: HYP_CODES
2335801000000114 SNOMED Stage 1 hypertension (NICE 2011) with evidence of end organ damage diagnostic res200: HYP_CODES
24184005 SNOMED Finding of increased blood pressure diagnostic res200: HYP_CODES G20..
2470030014 SNOMED Malignant secondary renovascular hypertension diagnostic res200: HYP_CODES
2470031013 SNOMED Benign secondary hypertension diagnostic res200: HYP_CODES
2478822013 SNOMED Secondary benign renovascular hypertension diagnostic res200: HYP_CODES
2532161014 SNOMED Hypertension secondary to endocrine disorder diagnostic res200: HYP_CODES
2671386015 SNOMED Hypertensive disorder, systemic arterial diagnostic res200: HYP_CODES
2920698012 SNOMED Blood pressure elevation diagnostic res200: HYP_CODES
299676019 SNOMED Secondary malignant renovascular hypertension diagnostic res200: HYP_CODES
299678018 SNOMED Secondary benign hypertension diagnostic res200: HYP_CODES
299681011 SNOMED Hypertension secondary to endocrine disorders diagnostic res200: HYP_CODES
3135013 SNOMED Benign essential hypertension diagnostic res200: HYP_CODES
31992008 SNOMED Secondary hypertension diagnostic res200: HYP_CODES G24.., Gyu2..
3763241013 SNOMED Endocrine hypertension diagnostic res200: HYP_CODES
38341003 SNOMED Hypertensive disease diagnostic res200: HYP_CODES G2_, G20.., G2y.., G2z, Gyu2..
389331000006110 SNOMED [X]Hypertension secondary to other renal disorders diagnostic res200: HYP_CODES
389341000006117 SNOMED [X]Hypertensive diseases diagnostic res200: HYP_CODES
413461000006118 SNOMED [X]Other secondary hypertension diagnostic res200: HYP_CODES
48146000 SNOMED Diastolic hypertension diagnostic res200: HYP_CODES G20..
490277011 SNOMED BP - High blood pressure diagnostic res200: HYP_CODES
490278018 SNOMED Systemic arterial hypertension diagnostic res200: HYP_CODES
490280012 SNOMED HBP - High blood pressure diagnostic res200: HYP_CODES
490281011 SNOMED HT - Hypertension diagnostic res200: HYP_CODES
490282016 SNOMED High blood pressure disorder diagnostic res200: HYP_CODES
490283014 SNOMED BP+ - Hypertension diagnostic res200: HYP_CODES
503982017 SNOMED Accelerated essential hypertension diagnostic res200: HYP_CODES
508416019 SNOMED Accelerated secondary hypertension diagnostic res200: HYP_CODES
523801000006119 SNOMED BP - hypertensive disease diagnostic res200: HYP_CODES
53452019 SNOMED Secondary hypertension diagnostic res200: HYP_CODES
56218007 SNOMED Systolic hypertension diagnostic res200: HYP_CODES G20..
59621000 SNOMED Essential hypertension diagnostic res200: HYP_CODES G20..
64168014 SNOMED Hypertensive disease diagnostic res200: HYP_CODES
64172013 SNOMED High blood pressure diagnostic res200: HYP_CODES
64173015 SNOMED Hypertensive vascular disease diagnostic res200: HYP_CODES
64174014 SNOMED Hypertensive vascular degeneration diagnostic res200: HYP_CODES
64176011 SNOMED Hypertension diagnostic res200: HYP_CODES
648911000006113 SNOMED Essential hypertension NOS diagnostic res200: HYP_CODES
73410007 SNOMED Secondary benign renovascular hypertension diagnostic res200: HYP_CODES G24..
78975002 SNOMED Malignant essential hypertension diagnostic res200: HYP_CODES G20..
80224019 SNOMED Diastolic hypertension diagnostic res200: HYP_CODES
843821000000102 SNOMED Stage 1 hypertension diagnostic res200: HYP_CODES G25..
843841000000109 SNOMED Severe hypertension diagnostic res200: HYP_CODES G26
846371000000103 SNOMED Stage 2 hypertension diagnostic res200: HYP_CODES G28
884121000006111 SNOMED Malignant hypertension diagnostic res200: HYP_CODES
89242004 SNOMED Malignant secondary hypertension diagnostic res200: HYP_CODES G24..
908631000000108 SNOMED Stage 1 hypertension (NICE 2011) without evidence of end organ damage diagnostic res200: HYP_CODES G25..
908651000000101 SNOMED Stage 1 hypertension (NICE 2011) with evidence of end organ damage diagnostic res200: HYP_CODES G25..
93494011 SNOMED Systolic hypertension diagnostic res200: HYP_CODES
99042012 SNOMED Essential hypertension diagnostic res200: HYP_CODES
99044013 SNOMED Idiopathic hypertension diagnostic res200: HYP_CODES
99046010 SNOMED Systemic primary arterial hypertension diagnostic res200: HYP_CODES
99047018 SNOMED Primary hypertension diagnostic res200: HYP_CODES

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