Racial and Disaggregated Ethnic Disparities of Blood Pressure Control in Community Health Centers

Background: Hypertension is the most prevalent reversible risk for cardiovascular morbidity and mortality. Blood pressure (BP) control is poor nationally and varies by race/ethnicity, and there is minimal understanding of the impact of country of origin. Objective: To examine racial/ethnic disparities in BP control among high-risk patients and among Latino patients disaggregated by country of origin. Design, Patients, Main Measures: Using electronic health record data from 1604 community-based clinics and employing logistic regression adjusted for patient-level covariates, control of final recorded BP (< 130/80) was assessed by race, ethnicity, language preference, and country of origin in 298,860 adult patients with at least one high-risk condition (diabetes, heart, vascular, chronic kidney disease) from 2012 to 2020. Data analysis was conducted from June 2023 to March 2024. Key Results: 40.5% of all patients had a final BP reading of < 130/80 (controlled BP). Compared with non-Latino White, non-Latino Black patients showed the lowest odds of BP control (0.69 [95% CI 0.68–0.71]) and Latino patients the highest (OR 1.19, 95% CI 1.17–1.22), with Spanish-preferring and foreign-born subgroups driving that advantage. Foreign-born Latino patients showed the highest odds of BP control compared with non-Latino White patients (OR 1.42 [95% CI 1.37–1.48]), ranging widely by country of origin. Conclusions: Race/ethnic disparities in BP control are evident in a multistate network of community-based health centers with significant variability by country of origin among Latino patients. Findings have vast implications for informing equitable clinical and public health strategies to treat patients with demonstrated difficulty achieving and maintaining BP control.