Abstract

Introduction: Health systems are increasingly leveraging real-world data to improve community health outcomes. Methods: We conducted a longitudinal assessment of health outcomes in patients with severe hypertension using electronic health record data from the Sentara Healthcare System 2010-2021. Severe hypertension was defined as at least two consecutive blood pressure (BP) readings above 160/100 mmHg. We examined follow-up visit rates at 3 and 6 months, and BP control rates (<140/90 mmHg) at 6 and 12 months after the second BP elevation. We also assessed the incidence of cardiovascular disease (CVD) until the end of 2022. Results: The study included 75,657 patients with severe hypertension. Mean age was 61.5 (13.9) years; 55% were female, 57% were White, 37% were Black, and 21.3% had a history of CVD. The median follow-up time was 3.8 years. Among patients with severe hypertension, 72% and 84% had follow-up visits at 3 and 6 months; 38% and 41% achieved BP control at 6 and 12 months. Among patients without prior history of CVD, 22.5% experienced at least one cardiovascular event during the follow-up, including 8.7% with coronary arteriosclerosis, 11.9% with heart failure, 65.2% with cerebral infarction, and 3.5% with myocardial infarction. The median time to cardiovascular events was 793 days. The risk of CVD was significantly higher in Black and older patients, as well as those with blood pressure levels exceeding 180/120 mmHg. Conclusions: This study successfully identified a longitudinal digital cohort of patients with severe hypertension and linked it to health outcomes. The findings have implications for health systems utilizing real-world data in population health research.

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