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Clinical Effectiveness Group

New research highlights inequities in blood pressure control

A study of adults diagnosed with persistent high blood pressure (hypertension) has found that people who are younger or of Black ethnicity are less likely to have their blood pressure successfully controlled. This puts them at increased risk of heart attack and stroke.

Photo of a health professional checking a patient's blood pressure

Researchers led by the Clinical Effectiveness Group analysed non-identifiable data from 150,000 GP health records from north east London. Despite the region being one of the most disadvantaged in the UK, the results show that the percentage of hypertension patients whose blood pressure is well-controlled is better than the national average , but there are significant inequalities. 

People from Black /Black British ethnic groups with hypertension were 10% less likely to have controlled blood pressure than those in White ethnic groups. The study found this was not due to associations with age, sex, deprivation or less frequent blood pressure checks. In fact, people from Black groups were more likely to have a blood pressure recording within the past year. A previous study found no difference in blood pressure control between African/African Caribbean and European groups in the UK when only considering patients who adhered to their medication schedule. This suggests that adherence may be a factor, with the cost of prescriptions presenting a possible barrier for all people of working age.

Patients under 50 years of age were 40% less likely to have controlled blood pressure than those older. Having poorly controlled blood pressure at a younger age potentially adds more years of strain on the cardiovascular system, which can result in higher risk of heart attack or stroke during a person’s lifetime. Almost one in five people with hypertension in north east London are under the age of 50, so this inequity affects a significant number of people. The disparity is a unique finding to this study and more research is needed to understand the factors driving it.

The authors say that targeted interventions to control blood pressure in Black ethnic groups and younger people would be an important step in addressing unequal outcomes, both in north east London and across the UK. The impact of medication costs in younger, working-age groups should be seriously considered, including the role of ‘single pill’ medications for hypertension that reduce patient costs and improve adherence. 

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