Abstract Body: Introduction
Hypertension is a leading cardiovascular risk factor affecting 46.7% of adults in the United States, yet the definitions of blood pressure (BP) control by society guidelines and quality metrics are not aligned. In 2017, the AHA/ACC guidelines redefined hypertension as BP >130/80 while the National Committee for Quality Assurance (NCQA) continues to define control as BP of <140/90. Further, the AHA/ACC guidelines emphasize the importance of using an average of readings, whereas the NCQA determination of control is based entirely on the last recorded BP measured closest to the end of the calendar year. This analysis investigates the odds of BP control based on average office BPs recorded between January and December 2023 compared with BP control based on the last recorded single BP measurement of 2023.

Hypothesis
At the population level, odds of BP control based on last recorded BP is a proxy for odds of BP control based on average BPs over the past calendar year.

Methods
We examined BP control for patients aged 18-85 with hypertension who had ≥3 outpatient measurements between 1/1/2023-12/31/2023 in a New York City health system. The odds of BP control based on average BP compared with last BP at <140/90 and <130/80 thresholds were assessed using logistic regression.

Results
Office BP measurements were analyzed for 89,130 patients. Of these, 71.2% had controlled hypertension based on NCQA criteria of last measured BP <140/90 versus 68.9% using the average BP <140/90. Using the lower <130/80 threshold, 34.5% patients had controlled hypertension by the last measured BP versus 32.7% using the average BP. When last systolic BP >140 or diastolic BP >90 there was a greater likelihood that the patient had uncontrolled hypertension based on average BP (OR 2.00, 95% CI [1.88-2.12] and 7.43, 95% CI [6.96-7.93] respectively). A similar pattern was observed when the last recorded systolic BP was >130 or diastolic BP >80, (OR: 2.02, 95% CI [1.95-2.08] and 3.99, 95% CI [3.87-4.12] respectively).

Conclusions
Although a single BP measurement may not be predictive of individual cardiovascular risk, the use of last measured BP to assess control at a population level is a reasonable approach to compare health systems and identify disparities.