Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA.
Utah Department of Health and Human Services, Salt Lake City, UT, USA.
BMC Prim Care. 2024 Aug 20;25(1):311. doi: 10.1186/s12875-024-02511-4.
Hypertension is a common heart condition in the United States (US) and severely impacts racial and ethnic minority populations. While the understanding of hypertension has grown considerably, there remain gaps in US healthcare research. Specifically, there is a lack of focus on undiagnosed and uncontrolled hypertension in primary care settings.
The present study investigates factors associated with undiagnosed and uncontrolled hypertension in primary care patients with hypertension. The study also examines whether Black/African Americans are at higher odds of undiagnosed and uncontrolled hypertension compared to White patients.
A cross-sectional study was conducted using electronic health records (EHR) data from the University of Utah primary care health system. The study included for analysis 24,915 patients with hypertension who had a primary care visit from January 2020 to December 2020. Multivariate logistic regression assessed the odds of undiagnosed and uncontrolled hypertension.
Among 24,915 patients with hypertension, 28.6% (n = 7,124) were undiagnosed and 37.4% (n = 9,319) were uncontrolled. Factors associated with higher odds of undiagnosed hypertension included age 18-44 (2.05 [1.90-2.21]), Hispanic/Latino ethnicity (1.13 [1.03-1.23]), Medicaid (1.43 [1.29-1.58]) or self-pay (1.32 [1.13-1.53]) insurance, CCI 1-2 (1.79 [1.67-1.92]), and LDL-c ≥ 190 mg/dl (3.05 [1.41-6.59]). For uncontrolled hypertension, risk factors included age 65+ (1.11 [1.08-1.34]), male (1.24 [1.17-1.31]), Native-Hawaiian/Pacific Islander (1.32 [1.05-1.62]) or Black/African American race (1.24 [1.11-1.57]) , and self-pay insurance (1.11 [1.03-1.22]).
The results of this study suggest that undiagnosed and uncontrolled hypertension is prevalent in primary care. Critical risk factors for undiagnosed hypertension include younger age, Hispanic/Latino ethnicity, very high LDL-c, low comorbidity scores, and self-pay or medicaid insurance. For uncontrolled hypertension, geriatric populations, males, Native Hawaiian/Pacific Islanders, and Black/African Americans, continue to experience greater burdens than their counterparts. Substantial efforts are needed to strengthen hypertension diagnosis and to develop tailored hypertension management programs in primary care, focusing on these populations.
高血压是美国常见的心脏疾病，严重影响着少数族裔人群。尽管人们对高血压的认识有了显著提高，但美国的医疗保健研究仍存在空白。具体来说，在初级保健环境中，人们对未确诊和未得到控制的高血压重视不足。
本研究旨在探讨与高血压患者中未确诊和未得到控制的高血压相关的因素。本研究还探讨了与白人患者相比，黑人和非裔美国人是否更有可能患有未确诊和未得到控制的高血压。
本研究采用了来自犹他大学初级保健医疗系统的电子健康记录（EHR）数据，开展了一项横断面研究。该研究纳入了 2020 年 1 月至 2020 年 12 月期间有初级保健就诊记录的 24915 例高血压患者进行分析。多变量逻辑回归评估了未确诊和未得到控制的高血压的几率。
在 24915 例高血压患者中，28.6%（n=7124）未被确诊，37.4%（n=9319）未得到控制。与未确诊高血压几率更高相关的因素包括年龄 18-44 岁（2.05[1.90-2.21]）、西班牙裔/拉丁裔（1.13[1.03-1.23]）、医疗补助（1.43[1.29-1.58]）或自付（1.32[1.13-1.53]）保险、CCI 1-2（1.79[1.67-1.92]）和 LDL-c≥190mg/dl（3.05[1.41-6.59]）。对于未得到控制的高血压，风险因素包括年龄 65 岁以上（1.11[1.08-1.34]）、男性（1.24[1.17-1.31]）、美国原住民/太平洋岛民（1.32[1.05-1.62]）或黑人/非裔美国人（1.24[1.11-1.57]）和自付保险（1.11[1.03-1.22]）。
本研究结果表明，未确诊和未得到控制的高血压在初级保健中较为普遍。未确诊高血压的关键风险因素包括年轻、西班牙裔/拉丁裔、极高的 LDL-c、低合并症评分和自付或医疗补助保险。对于未得到控制的高血压，老年人群、男性、美国原住民/太平洋岛民和黑人/非裔美国人的高血压负担仍然高于其他人群。需要做出巨大努力来加强高血压的诊断，并在初级保健中制定针对这些人群的高血压管理计划。
