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Is the rule of halves still relevant today? A cross-sectional analysis of hypertension detection, treatment and control in an urban community

Wu, Alice S.; Dodhia, Hiten; Whitney, David; Ashworth, Mark

doi: 10.1097/HJH.0000000000002192

Aims: To estimate percentages of patients with undiagnosed hypertension, diagnosed untreated hypertension and diagnosed, treated and uncontrolled hypertension and to identify sociodemographic factors for diagnosed, uncontrolled hypertension and not having a blood pressure (BP) reading recorded.

Methods: Data from 320 094 patients aged 18 to less than 80 years from general practices in inner London was analysed using both last recorded BP (blood pressure) and mean BP. Logistic regression models identified factors associated with uncontrolled hypertension and no recorded BP.

Results: Twenty-nine thousand, seven hundred and nineteen (9.3%) patients had a recorded diagnosis of hypertension. On the basis of analysis of the last BP value, 14.2% (n = 4207) were untreated and 46.3% (n = 13 749) had uncontrolled hypertension; 10.0% (n = 28 274) without a prior hypertension diagnosis had undiagnosed hypertension. Corresponding values based on mean BP analysis were 8.9% (n = 2367) untreated, 51.5% (n = 13 734) uncontrolled; 4.1% (n = 11 446) undiagnosed. 17.5% (n = 55 960) had no recorded BP value.

Black ethnicity was a predictor of uncontrolled hypertension: compared with the White British population, the adjusted odds ratio (AOR) for the Black African population was 1.39 (95% CI: 1.25–1.53) and for the Black Caribbean was 1.31 (95% CI: 1.19–1.45). The White Other group were most likely to have no record of BP measurement (AOR: 1.52; 95% CI: 1.47–1.57); conversely, unrecorded BP was less likely in the Black African (AOR: 0.79; CI: 0.74–0.83) and Black Caribbean (AOR: 0.71; CI: 0.66–0.76) groups, relative to the White British population.

Conclusion: In an inner-city, multiethnic population, the ‘rule of halves’ still broadly applies to the diagnosis and control of hypertension, although only a small proportion were untreated.

King's College, London, UK

Correspondence to Alice S. Wu, Lambeth CCG, 1, Lower Marsh Street, Lambeth, London SE1 7NT, UK. E-mail:

Abbreviations: ABPM, ambulatory blood pressure monitoring; ACE, angiotensin-converting enzyme; ACR, albumin creatinine ratio; CHD, coronary heart disease; CKD, chronic kidney disease; CVD, cardiovascular disease; HBPM, home ambulatory blood pressure monitoring; HSE, Health Survey for England; LLSOA, lower layer super output area; NHS, National Health Service; NICE, The National Institute for Health and Care Excellence; PAD, peripheral arterial disease; PHE, Public Health England; QOF, Quality and Outcomes Framework; SNOMED, Systematized Nomenclature of Medicine; STIA, Stroke and Transient Ischaemic Attack

Received 25 February, 2019

Revised 6 June, 2019

Accepted 14 June, 2019

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