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The association of area deprivation index and blood pressure control and therapeutic inertia among older adults with hypertension

Journal of Human Hypertension (2025)Cite this article

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Abstract

Neighborhood characteristics may influence patient and clinician management of blood pressure (BP) control. This study examined the association of the Area Deprivation Index (ADI) with uncontrolled BP ( ≥ 140/90 mmHg) at primary care visits and therapeutic inertia (TI) during visits with uncontrolled BP. Data included 52 750 visits among 8 434 patients aged ≥65 years across nine outpatient clinics in Chicago suburbs between January 1, 2017, and March 10, 2020. ADI represents national percentiles of census block group deprivation (0 = least, 100 = most deprived). TI was defined as no initiation or escalation of BP-lowering medication during visits with uncontrolled BP. Adjusted prevalence ratios (PRs) of uncontrolled BP and TI by ADI quartiles were estimated using generalized estimating equations. Mean age was 74.3 years (SD 7.8), 42.3% were male, 69.1% Non-Hispanic (NH) White, 15.9% NH Black, and 8.2% Hispanic. Uncontrolled BP occurred in 33.8% of visits. Of those, 73.4% experienced TI. There was no significant association between ADI and uncontrolled BP in adjusted models. Adjusted PRs of TI were higher in ADI Q2 (PR 1.03, 95% CI: 1.00-1.06) and Q3 (PR 1.04 (95% CI: 1.01-1.07), but not Q4 compared to Q1. ADI modeled continuously with splines showed modest increases in adjusted predicted prevalence of both outcomes, although confidence intervals widened at the extremes. Neighborhood deprivation may contribute to disparities in hypertension management but more studies with larger number of patient visits at the extremes of ADI distribution are needed.

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Data availability

The datasets generated and/or analyzed during the current study are not publicly available due to institutional policies and patient privacy protections but are available from the corresponding author upon reasonable request and with permission of the Loyola University Chicago Institutional Review Board.

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Acknowledgements

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Funding

Loyola University Chicago Center for Health Outcomes and Informatics Research.

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Author notes

  1. X: @kramer_holly

Authors and Affiliations

  1. Departments of Health Informatics and Data Science, Loyola University Chicago, Maywood, IL, USA

    Michael T. Saban & Samie Tootooni

  2. Public Health Sciences, Loyola University Chicago, Maywood, IL, USA

    Talar W. Markossian, Grant T. Hiura & Holly J. Kramer

  3. The Clinical Research Office, Loyola University Chicago, Maywood, IL, USA

    Amy Wozniak

  4. Emergency Medicine, Loyola University Chicago, Maywood, IL, USA

    Beatrice Probst

  5. Loyola Physician Partners, Loyola University Chicago, Maywood, IL, USA

    Katherine Habicht

  6. Medicine, Loyola University Chicago, Maywood, IL, USA

    Holly J. Kramer

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Contributions

All authors meet the ICMJE authorship criteria. Conceptualization: HK, ST, TWM. Methodology: MTS, ST, AW, HK. Data curation: GTH. Formal analysis: MTS, AW. Visualization: MTS. Investigation/Resources: MTS, BP, TM, HK. Writing – original draft: MTS. Writing – review & editing: All authors. Supervision: HK, ST, TWM.

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Correspondence to Holly J. Kramer.

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This study was reviewed by the Loyola University Chicago Institutional Review Board and deemed exempt from human subjects review. All methods were carried out in accordance with relevant guidelines and regulations. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

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Saban, M.T., Tootooni, S., Markossian, T.W. et al. The association of area deprivation index and blood pressure control and therapeutic inertia among older adults with hypertension. J Hum Hypertens (2025). https://doi.org/10.1038/s41371-025-01067-9

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