Trends in uncontrolled hypertension highlight the need for targeted strategies

Federally Qualified Health Centers (FQHCs) offer comprehensive health services to people in communities across the country, regardless of their ability to pay. Millions of Americans rely on FQHCs to help manage long-term conditions, such as hypertension (high blood pressure) and other health needs. In 2020 and 2021, these so-called “safety net providers” faced unprecedented challenges. Researchers representing CEAL’s Network for Community-Engaged Primary Care Research wanted to learn about the impact of this period, characterized by disruptions to health care access and routine medical care, on hypertension control.

The team analyzed trends in uncontrolled hypertension among FQHC patients at the state level from 2019 to 2022. Using data from the Health Center Program Uniform Data System, the team grouped states by the prevalence of uncontrolled hypertension. They also analyzed the groups based on key demographic data that are reported by the FQHCs. Having established these groups, the team looked for common trends.

The researchers’ findings

• The team found a similar trend across the groups. On the whole, rates of uncontrolled hypertension in FQHC patients rose from 2019 to 2020, remained elevated in 2021, and then declined from 2021 to 2022, back down closer to 2019 levels. This points to the impact of health care service disruptions on the management of hypertension.
• Five states showed consistently high uncontrolled hypertension rates: Mississippi, Wyoming, Alabama, Delaware, and Alaska. Patients in these states may benefit from targeted strategies to control hypertension.
• Though most states saw lower rates of uncontrolled hypertension by 2022, there were persistent differences between the demographic groups. These differences highlight the need for continued attention to the management of chronic disease in communities most in need.

The evidence-based opportunities

Based on their findings, the researchers identified a range of targeted interventions to help repair ongoing differences in health outcomes across communities:

• Health centers can increase outreach efforts, including remote monitoring, to continuously offer support with blood pressure management.
• Health systems can develop plans to support ongoing chronic disease management in times of broad disruption to health care access.
• Policymakers can take action to sustain and grow telehealth infrastructure to promote access.
• State health departments can partner with FQHCs to provide targeted interventions to communities most in need. 

The researchers underscore that identifying those states in which uncontrolled hypertension is more common allows a view into how to target interventions and apply resources. This could help FQHCs maintain their ability to provide crucial support for those with hypertension and other chronic conditions.