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

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. Method 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. HOW THIS FITS IN Health inequities in the management of long-term conditions are widely recognised. This study identifies ethnic, age, gender and deprivation inequities in the control of blood pressure in a large unselected cohort of adults with hypertension in an ethnically diverse and nationally disadvantaged area of London. It confirms previous findings that blood pressure control in Black ethnic groups with hypertension is worse than in White or Asian ethnic groups. These differences were not related to access to blood pressure recording or treatment intensity. Younger adults were less likely to have controlled hypertension than older adults. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was supported by Barts Charity and Health Data Research UK, an initiative funded by UK Research and Innovation, Department of Health and Social Care (England) and the devolved administrations, and leading medical research charities. OR is supported by the National Institute for Health Research (NIHR) and a Drayson research fellowship. RM is supported by Barts Charity (MGU0504). ZR-E is supported by an NIHR Integrated Academic Training programme and her Academic Clinical Lectureship post and is also supported by a British Heart Foundation Clinical Research Training Fellowship (FS/17/81/33318). CC is supported by an NIHR School of Primary Care Research Clinical Fellowship Queen Mary University of London. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This was confirmed by the Chair of the North East London Strategic Information Governance Network. The clinical effectiveness group (CEG) has the written consent of all practices in the study area to use pseudonymised patient data for audit and research for patient benefit. The CEG is the data processor, and the General Practices in the study are the data controllers. The researchers adhere to the data protection principles of the Data Protection Act 2018, and all data was managed according to UK NHS information governance requirements. All data were pseudonymised and are only presented in aggregate form. The NHS Health Research Authority toolkit () identified that Research Ethics Approval was not required for this project. This was confirmed by the Chair of the North East London Strategic Information Governance Network. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors