Undiagnosed and Uncontrolled Hypertension at a Federally Qualified Health Center

Hypertension is a leading preventable risk factor for cardiovascular disease and mortality, yet is often uncontrolled and undiagnosed. Federally Qualified Health Centers (FQHC) serve vulnerable and understudied populations having characteristics that are associated with greater risk for undiagnosed and uncontrolled hypertension. This study aimed to determine the burden and risk factors associated with undiagnosed and uncontrolled hypertension at a large FQHC. The design was a retrospective cross-sectional study of adult patients seen at an FQHC between 2019–2023. Undiagnosed hypertension was defined as an elevated average blood pressure reading over at least two encounters within the same year. Hypertension was defined according to the 2017 ACC/AHA guidelines. Descriptive statistics estimated rates and mixed-effects logistic regression identified risk factors. From 2019 to 2023, the yearly percent of undiagnosed hypertension ranged from 24.4–31.3% and 5.3–7.5% for undiagnosed stage 2 hypertension. From 2019 to 2023, the yearly burden of uncontrolled hypertension ranged from 74.2–78.7% and 57.7–63.2% for uncontrolled stage 2 hypertension. Factors associated with higher rates of undiagnosed hypertension included older age, male sex, and Black race. Factors associated with higher rates of uncontrolled hypertension included male sex, Black race, language preference, and self-pay insurance. There was a substantial burden of undiagnosed hypertension and uncontrolled hypertension that aligns with national prevalences despite serving a vulnerable patient population. Within FQHCs, quality improvement programs to improve the assessment and control of hypertension require race, language preference, and insurance status considerations to effectively reduce cardiovascular disease and events.