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Hypertension in Florida: Data From the OneFlorida Clinical Data Research Network

PEER REVIEWED

There were 10,659,174 unique patients in OneFlorida Data Trust as of June 30, 2016. Of these, 5,638,048 were excluded because they were aged <18 years. These exclusions left 5,021,126 adults aged ≥18 years with EHR data. Of these, 915,071 were excluded because they had no encounter during the study period. These exclusions left 4,106,055 adults with ≥1 encounter between January 1, 2012, and June 30, 2016. Of these, 1,096,000 were excluded because they had no ambulatory encounter during the study period. Of the 3,010,055 adults with ≥1 ambulatory visit or other ambulatory encounter, 570,664 had an ICD-9–based or ICD-10-CM–based hypertension diagnosis. Of these, 454,818 had ≥1 valid blood pressure recorded in the EHR and 115,846 had no valid blood pressure recorded in the EHR. Of the 3,010,055 adults with ≥1 ambulatory visit or other ambulatory encounter, no hypertension diagnosis was recorded for 2,439,391. Of these, 1,396,647 had ≥1 valid blood pressure recorded in the EHR and 1,042,744 had no valid blood pressure recorded in the EHR. Of those with no hypertension diagnosis recorded and ≥1 valid blood pressure recorded in the EHR, 267,805 had elevated blood pressure recorded in the EHR and 1,128,842 had no elevated blood pressure recorded in the EHR.

Figure 1.
Flow diagram for OneFlorida hypertensive cohort identification. Abbreviations: EHR, electronic health record; ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification(11); ICD-10-CM, International Classification of Diseases, Tenth Revision, Clinical Modification(12).

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Figure 2.
Prevalence, by quintile, of hypertension among patients with at least 1 ambulatory visit or outpatient encounter recorded from January 1, 2012, through June 30, 2016, in OneFlorida, a partnership of 11 health systems and affiliated practices in Florida, by county. Panel A, prevalence of diagnosed hypertension; panel B, prevalence of hypertension, both diagnosed and undiagnosed; panel C, prevalence of elevated blood pressure but no hypertension diagnosis.

County Diagnosed Hypertension, % All Hypertension, Diagnosed and Undiagnosed, % Elevated Blood Pressure With No Hypertension Diagnosis, %
Alachua 22.5 30.3 10.2
Baker 31.2 37.6 10.3
Bay 18.9 32.8 19.6
Bradford 32.1 41.9 12.9
Brevard 13.0 25.1 21.9
Broward 12.9 26.7 17.6
Calhoun 41.3 48.8 9.0
Charlotte 19.0 28.0 16.9
Citrus 18.8 36.1 22.8
Clay 20.0 27.8 14.0
Collier 3.7 13.4 27.2
Columbia 25.9 37.3 16.0
DeSoto 10.1 18.5 18.8
Dixie 36.7 47.7 13.2
Duval 30.6 36.2 9.7
Escambia 19.0 35.0 21.1
Flagler 15.9 28.6 21.5
Franklin 43.1 50.8 10.7
Gadsden 46.0 54.2 10.9
Gilchrist 26.9 38.1 14.6
Glades 12.9 22.4 22.4
Gulf 25.4 37.8 17.9
Hamilton 29.6 41.9 17.2
Hardee 9.4 20.0 20.8
Hendry 10.9 24.9 22.5
Hernando 16.8 27.1 17.3
Highlands 12.9 24.6 24.1
Hillsborough 18.6 23.1 9.6
Holmes 27.6 39.3 17.5
Indian River 7.8 19.1 25.4
Jackson 40.2 48.8 11.7
Jefferson 44.8 52.0 8.8
Lafayette 26.2 37.3 15.5
Lake 15.5 27.7 20.2
Lee 18.1 26.1 15.0
Leon 32.5 42.5 14.1
Levy 28.8 40.5 15.2
Liberty 42.5 50.7 10.5
Madison 40.9 49.7 12.1
Manatee 9.5 19.3 20.2
Marion 18.7 32.7 18.8
Martin 6.9 19.0 26.2
Miami-Dade 13.5 25.2 15.2
Monroe 11.4 26.6 21.0
Nassau 30.9 38.4 11.3
Okaloosa 16.7 29.5 19.1
Okeechobee 10.9 20.7 25.4
Orange 18.7 25.5 14.2
Osceola 14.6 23.2 15.2
Palm Beach 11.0 23.8 19.1
Pasco 19.5 25.0 9.8
Pinellas 22.6 28.8 7.5
Polk 14.9 24.7 16.9
Putnam 26.5 39.9 17.9
Santa Rosa 13.2 28.4 20.3
Sarasota 11.3 23.6 19.6
Seminole 15.5 23.1 14.6
St. Johns 15.0 23.4 14.9
St. Lucie 7.6 18.9 25.4
Sumter 18.3 35.1 22.5
Suwannee 25.4 38.0 17.8
Taylor 41.8 51.3 12.7
Union 26.1 36.9 14.6
Volusia 13.1 23.1 18.7
Wakulla 35.9 44.0 10.7
Walton 20.5 32.9 17.5
Washington 27.0 39.0 16.9

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Figure 3.
Prevalence, by quintile, of uncontrolled blood pressure (≥140/90 mm Hg) among hypertensive patients with at least 1 ambulatory visit or outpatient encounter recorded from January 1, 2012, through June 30, 2016, in OneFlorida, a partnership of 11 health systems and affiliated practices in Florida, by county. Panel A, prevalence of uncontrolled blood pressure, regardless of hypertension diagnosis; panel B, prevalence of uncontrolled blood pressure only among those with a hypertension diagnosis.

County All Uncontrolled Blood Pressure, % Uncontrolled Blood Pressure, Diagnosed Hypertension Only, %
Alachua 55.5 35.7
Baker 54.1 33.8
Bay 65.8 31.2
Bradford 53.7 35.7
Brevard 70.6 28.2
Broward 72.8 42.5
Calhoun 44.2 30.3
Charlotte 65.2 27.8
Citrus 70.2 38.2
Clay 59.3 28.7
Collier 85.6 38.6
Columbia 60.5 34.9
DeSoto 68.0 34.5
Dixie 57.5 42.5
Duval 54.2 35.4
Escambia 68.1 33.5
Flagler 68.4 32.6
Franklin 46.8 30.9
Gadsden 47.1 31.2
Gilchrist 60.1 39.0
Glades 67.0 27.0
Gulf 56.9 25.6
Hamilton 60.2 34.6
Hardee 72.2 30.0
Hendry 77.0 39.1
Hernando 59.1 25.9
Highlands 71.2 26.9
Hillsborough 55.8 24.9
Holmes 65.2 33.3
Indian River 79.7 31.7
Jackson 46.6 27.7
Jefferson 36.8 23.9
Lafayette 60.3 36.2
Lake 73.3 20.5
Lee 64.1 30.0
Leon 51.2 27.3
Levy 58.8 38.4
Liberty 43.3 27.1
Madison 43.2 25.2
Manatee 71.4 33.0
Marion 66.4 36.5
Martin 78.2 33.3
Miami-Dade 69.1 40.3
Monroe 80.7 50.8
Nassau 52.5 33.2
Okaloosa 65.0 29.9
Okeechobee 65.2 20.7
Orange 59.3 20.5
Osceola 62.6 25.8
Palm Beach 73.0 39.8
Pasco 53.0 26.8
Pinellas 54.4 41.3
Polk 64.8 28.3
Putnam 62.6 37.7
Santa Rosa 73.4 37.1
Sarasota 70.1 30.2
Seminole 61.1 21.8
St. Johns 63.3 32.7
St. Lucie 78.5 35.0
Sumter 63.9 34.2
Suwannee 62.2 35.9
Taylor 45.8 28.7
Union 56.6 33.4
Volusia 69.3 29.4
Wakulla 45.2 26.8
Walton 62.4 32.3
Washington 61.3 32.8

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