Introduction

Hypertension is a major contributor to cardiovascular disease and remains disproportionately high among Black adults in the U.S. Despite improvements in awareness and self‑monitoring, gaps persist in diagnosis and control, and sex differences may further influence risk. Primary care plays a key role in identifying and treating hypertension, yet the extent to which race/ethnicity and sex disparities continue remains unclear.

 Methods

We conducted a retrospective cohort study using University of Utah primary care EHR data from 2015–2025. Adults with ≥2 primary care visits and ≥2 blood pressure measurements were included, excluding those with end‑stage renal disease. Hypertension, undiagnosed hypertension, and uncontrolled hypertension were defined using ICD‑10 codes, treatments, and blood pressure thresholds (≥140 mmHg or ≥90 mmHg). Sociodemographic and clinical factors were extracted, and Poisson regression with robust error was used to estimate unadjusted and adjusted RR (95% CI).

 Results

Among the 301,9322 patients in the study, 213,609 (71%) were hypertensive (diagnosed, undiagnosed, or treated) at some point during follow-up. Among those with hypertension, 118,452 (55%) were undiagnosed, and 54,389 (25%) were uncontrolled. In our adjusted models, we found a lower risk of undiagnosed hypertension but higher risk of uncontrolled hypertension for older vs younger, male vs female, and black/African American or Native Hawaiian/other Pacific Islander vs non-Hispanic white patients. Patients who were Asian, Middle Eastern/North African, or other all had a lower risk of both undiagnosed and uncontrolled hypertension.

 Conclusion

Our results highlight the need for primary care and public health systems to strategically apply social risk profiles to guide targeted interventions that improve hypertension detection and control. Further research assessing other social drivers of hypertension control including geographic residence will provide a more complete picture.