Background: Hypertension is a key potentially modifiable risk factor for cardiovascular disease- the leading cause of death in the UK. Good blood pressure (BP) control reduces mortality; however, health inequalities may lead to variability in hypertension management. Aim: To investigate health inequities related to ethnicity, sex, age, and socio-economic status in the treatment and control of BP in a large cohort of adult patients with hypertension. Design and Setting: A cross-sectional cohort study of adults with hypertension registered with general practices in North East London on 1st April 2019. Method: Multivariable logistic regression was used to estimate associations of demographics and treatment intensity on the following hypertension management indicators: 1) BP recording in last 12 months, 2) BP on age-adjusted target, 3) BP on age-adjusted target and BP recorded in last 12 months. Results: In total, 156,296 adults were included. Black/Black British ethnic groups were less likely to have controlled BP than White ethnic groups (OR 0.89, 95% CI = 0.86-0.92). Asian/Asian British ethnic groups were more likely to have controlled blood pressure (OR 1.29, 95% CI = 1.25-1.34). Ethnic differences in control could not be explained by the likelihood of having a recent blood pressure recording, nor by treatment intensity differences. Older adults were more likely to have controlled hypertension than younger patients. Conclusion: Black/Black British and younger people are less likely to have controlled hypertension and may warrant targeted interventions. Possible explanations for these findings are presented and further research is needed on reasons for ethnic differences.

The authors have declared no competing interest.

This work was supported by Barts Charity and Health Data Research UK, an initiative funded by UK Research and Innovation, Department of Health and Social Care (England) and the devolved administrations, and leading medical research charities. OR is supported by the National Institute for Health Research (NIHR) and a Drayson research fellowship. RM is supported by Barts Charity (MGU0504). ZR-E is supported by an NIHR Integrated Academic Training programme and her Academic Clinical Lectureship post and is also supported by a British Heart Foundation Clinical Research Training Fellowship (FS/17/81/33318). CC is supported by an NIHR School of Primary Care Research Clinical Fellowship Queen Mary University of London. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

This was confirmed by the Chair of the North East London Strategic Information Governance Network. The clinical effectiveness group (CEG) has the written consent of all practices in the study area to use pseudonymised patient data for audit and research for patient benefit. The CEG is the data processor, and the General Practices in the study are the data controllers. The researchers adhere to the data protection principles of the Data Protection Act 2018, and all data was managed according to UK NHS information governance requirements. All data were pseudonymised and are only presented in aggregate form. The NHS Health Research Authority toolkit (http://www.hra-decisiontools.org.uk/ethics/) identified that Research Ethics Approval was not required for this project. This was confirmed by the Chair of the North East London Strategic Information Governance Network.

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All data produced in the present study are available upon reasonable request to the authors