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Undiagnosed and uncontrolled hypertension at a federally qualified health center

Journal of Human Hypertension (2026)Cite this article

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Abstract

Hypertension is a preventable risk factor for cardiovascular disease and mortality yet is often undiagnosed and uncontrolled. Federally Qualified Health Centers (FQHC) serve vulnerable, understudied populations having characteristics that are associated with greater risk for undiagnosed and uncontrolled hypertension. This study aimed to determine the burden and risk factors associated with undiagnosed and uncontrolled hypertension at a large FQHC, with the co-primary outcomes of yearly rates of undiagnosed and uncontrolled hypertension. The design was a retrospective cross-sectional study of adult patients seen at an FQHC between 2019–2023. Undiagnosed hypertension was defined as an elevated average blood pressure reading ( ≥ 130/80) over at least two encounters within the same year. Hypertension was defined according to the 2025 ACC/AHA guidelines, ≥130/80. Crude and age-adjusted rates for the co-primary outcomes were calculated and adjusted mixed-effects logistic regression identified risk factors. From 2019 to 2023, the yearly percent of age-adjusted undiagnosed hypertension ranged from 28.7–34.7%. From 2019 to 2023, the yearly burden of age-adjusted uncontrolled hypertension ranged from 74.0–79.5%, irrespective of treatment. Factors associated with higher rates of undiagnosed hypertension included older age (OR 1.04, 95% CI [1.04, 1.04]), male sex (2.9, [2.7, 3.2]) and Black race (1.3, [1.1, 1.4]). Factors associated with higher rates of uncontrolled hypertension included male sex (OR 1.2, 95% CI [1.1, 1.2]), Black race (1.5, [1.4, 1.7]), other language preference (1.3, [1.1, 1.4]), and self-pay insurance (1.2, [1.1, 1.4]). There was a substantial burden of undiagnosed and uncontrolled hypertension with intervention needed to reduce cardiovascular disease.

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Fig. 1: Forest plot of odds ratios for undiagnosed hypertension.
Fig. 2: Forest plot of odds ratios for uncontrolled hypertension.

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Data availability

The datasets analyzed during the current study are not publicly available given private health information, however may be available from the corresponding author on reasonable request.

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Acknowledgements

This research was possible because of the dedication and contribution of IT staff at Piedmont Health Services who were able to provide the necessary data.

Funding

This project/program is supported by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Resources (HHS) as part of an award. The contents are those of the authors and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the US Government.

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Authors and Affiliations

  1. Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA

    Anand Shah & Shannon Aymes

  2. Division of Cardiology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA

    Anand Shah & Ross J. Simpson

  3. Piedmont Health Services, Chapel Hill, NC, USA

    Joan East

  4. UNC Gillings School of Global Public Health, Chapel Hill, NC, USA

    Jan Lee Santos

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Contributions

AS helped conceive and design the work, performed statistical analysis, interpreted the results and drafted the manuscript. SA helped conceive the work, provided edits to the manuscript and approved the final version. JE helped conceive the work, provided edits to the manuscript and approved the final version. JS helped conceive the work, provided edits to the manuscript and approved the final version. RS played an important role in interpreting the results, provided edits to the manuscript and approved the final version.

Corresponding author

Correspondence to Anand Shah.

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Competing interests

JE works at Piedmont Health Services. There are no other competing or financial interests related to this work.

Ethical approval

This study was approved by the institutional review board at the University of North Carolina at Chapel Hill (21-1935) in 2023 and reviewed yearly thereafter. All methods were performed in accordance with relevant guidelines and regulations.

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Shah, A., Aymes, S., East, J. et al. Undiagnosed and uncontrolled hypertension at a federally qualified health center. J Hum Hypertens (2026). https://doi.org/10.1038/s41371-026-01114-z

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