Background: Racial disparities in blood pressure control in the U.S. have been well documented. In 2010, Kaiser Permanente Southern California (KPSC), a large and diverse integrated health care delivery system that provides care to over 4 million members, implemented a series of changes in health care delivery to address the disparity in hypertension control. Key elements included changes to the care team, patient activation, meaningful use of health information technology, and leadership vision.
Methods: We examined trends in hypertension control between 2008 and 2014 by race/ethnicity in KPSC members aged 18 years and older. Patients with hypertension were identified from the KPSC POINT® (Permanente Online Interactive Network Tool) population care management hypertension registry. Blood pressure control was defined according to JNC-7 criteria in the fourth quarter of each calendar year from 2008 through 2014.
Results: Between 2008 and 2014, the hypertension population increased from 624,493 to 745,382, while the prevalence was stable (25.9% in 2008 and 25.6% in 2014). During this period, the proportion of Whites and Blacks decreased slightly from 45.4% to 43.0% and 14.3% to 13.5%, respectively, while the proportion of Hispanics and Asian/Pacific Islanders increased from 25.2% to 29.0% and 9.8% to 11.3%, respectively. Hypertension control increased from 74.0% in 2008 to 83.8% in 2014 and increased across age, sex, and racial/ethnic groups (Figure). Blacks had the largest improvement in hypertension control (68.8% to 80.8%), which was primarily driven by those aged 65+ years. The disparity in hypertension control between Whites and Blacks decreased from 6.9% to 5% between 2008 and 2014.
Conclusions: While ecologic in nature, the secular increases in hypertension control suggest that implementation of a series of system-wide changes can affect all subpopulations.