Abstract Body: Introduction: The established paradigm of “awareness (i.e. diagnosis), treatment and control” as a central strategy to achieve blood pressure control is well accepted as the optimal approach to hypertension (HTN) management, but few studies have explored real-world patterns of healthcare engagement, treatment and blood pressure control within the first two years of diagnosis of HTN, and how they may differ for different sociodemographic patient groups. Methods: We analyzed electronic health records from a large integrated healthcare system in Northern California to characterize trajectories of clinical engagement, blood pressure treatment and control after incident HTN diagnosis. The cohort included 40,469 primary care patients between 2012-2019, with incident HTN. Each month for 24 months after diagnosis, patients were assigned to one of 8 mutually exclusive states for HTN treatment with medications (Y/N), blood pressure control (Y/N), and visit status (up to date Y/N). We applied sequence and cluster analysis to identify common types of BP management trajectories. Using multinomial logistic regression, we estimated associations between patients’ race and ethnicity and these trajectories. We hypothesized that more optimal engagement trajectories are less common among non-Hispanic Black (NHB) individuals, given well documented disparities in BP control among this patient subgroup. Results: We observed 20,564 distinct care management trajectories among individuals that were classified into four clusters representing “Control without medications” (36.4%), “Control with medications” (16.7%), “Medications without control” (10.7%), and “Minimal engagement” (36.2%). The first two of these were classified as optimal care management (OCM), representing 52.6% of individuals. By 24 months only 50% of patients were up to date with their visits, and more than one-third of patients (36.2%) exhibited virtually no follow-up visit after the initial index visit. Comparing OCM with medication to the minimal engagement, those who self-identify as NHB had significantly lower odds (OR [95%CI] 0.75 [0.6, 0.9]) of belonging to the OCM cluster compared to non-Hispanic white (NHW) counterparts. Conclusion: Patients who self-identify as NHB experienced lower odds of OCM compared to NHW. Future studies are needed to identify predictors of clinical engagement trajectories resulting in lack of clinical engagement post-diagnosis, and interventions to encourage better engagement.