Disparities in Hypertension Control Across and Within Three Health Systems Participating in a Data-Sharing Collaborative

J Am Board Fam Med. 2018 Nov-Dec;31(6):897-904. doi: 10.3122/jabfm.2018.06.180166.


Introduction: We aimed to standardize data collection from 3 health systems (HS1, HS2, HS3) participating in the San Francisco Bay Collaborative Research Network, and compare rates and predictors of uncontrolled blood pressure among hypertensive adults to identify opportunities for regional collaboration in quality improvement.

Methods: Retrospective cohort study using deidentified electronic health record data from all primary care patients with at least 1 visit in a 2-year period, using standard data definitions in a common data repository. Primary outcome was uncontrolled blood pressure at the most recent primary care visit.

Results: Of 169,793 adults aged 18 to 85 years, 53,133 (31.3%) had a diagnosis of hypertension. Of these, 18,751 (35%) had uncontrolled blood pressure at their last visit, with the proportion varying by system (29%, HS1; 31%, HS2; and 44%, HS3) and by clinical site within each system. In multivariate analyses, differences between health systems persisted, with HS2 and HS3 patients having a 1.15 times (95% CI, 1.11 to 1.19) and 1.46 times (95% CI, 1.42 to 1.50) greater relative risk of uncontrolled blood pressure compared with HS1. Across health systems, hypertensive patients were more likely to have uncontrolled blood pressure if they were uninsured, African Americans, current smokers, obese, or had fewer than 2 primary care visits during the 2-year measurement period.

Conclusions: After controlling for standard individual predictors of hypertension control, significant and substantial differences in hypertension control persisted between health systems, possibly due to local quality improvement programs among other factors. There may be opportunities to share best practices and address common disparities across health systems.

Keywords: Blood Pressure; Hypertension; Multivariate Analysis; Primary Health Care; Retrospective Studies Quality Improvement.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antihypertensive Agents / administration & dosage*
  • Blood Pressure / drug effects
  • Blood Pressure Determination
  • Female
  • Healthcare Disparities / statistics & numerical data*
  • Humans
  • Hypertension / diagnosis
  • Hypertension / drug therapy*
  • Male
  • Medically Uninsured / statistics & numerical data
  • Middle Aged
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians' / standards
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Primary Health Care / organization & administration*
  • Primary Health Care / standards
  • Primary Health Care / statistics & numerical data
  • Quality Improvement
  • Retrospective Studies
  • San Francisco
  • Treatment Outcome
  • Young Adult


  • Antihypertensive Agents