Access to Primary Care Linked to Improved Blood Pressure

Better access to primary care improves awareness and control of high blood pressure, new research shows.

The study, published in Circulation: Cardiovascular Quality and Outcomes, analyzed health data from more than 5000 predominantly Black adults living in Chicago.

People living in areas with more primary care providers were 27% less likely to have hypertension, compared with those in neighborhoods with the fewest such clinicians, the researchers reported.

“In many of these areas on the South Side of Chicago that are relatively underserved, better accessibility of primary care…is associated with better hypertension awareness and control,” said Brisa Aschebrook-Kilfoy, PhD, associate professor of public health sciences at the University of Chicago, who led the study.

While previous research has shown greater access to clinicians is associated with better health outcomes, the new study examined whether the protective effect extended to people living in less affluent neighborhoods.

Aschebrook-Kilfoy and colleagues analyzed the distance between a person’s home and local primary healthcare facilities; the physicians-to-population ratio; and the effect of distance to primary care on an individual’s willingness to seek primary healthcare.

They used data from the Chicago Multiethnic Prevention and Surveillance Study, or COMPASS, between 2013 to 2019. COMPASS is a long-term research program at the University of Chicago exploring how the health of Chicagoans is shaped by where they live. MAPSCorps, a nonprofit, provided location information for primary care professionals in the identified Chicago neighborhoods, which included family physicians, general practitioners, and general internists.

The majority of patients included in the study were Black (84%), 37.3% were obese, a little over half were current smokers, and over 53% reported an annual household income less than $15,000.

The researchers also incorporated scores on the Area Deprivation Index (ADI), which is based on neighborhood data such income, education, and employment. Most of the study population lived in Chicago neighborhoods with an ADI score higher than the 70th percentile, indicating lower socioeconomic status.

Patients were assigned a final score indicating their access to primary care based on these factors, with the highest quartile associated with the best access to primary care.

People with the most access to primary care were 27% less likely to have hypertension than those with the least access (odds ratio, 0.73; 95% CI, 0.60 – 0.89; P < .01).

“When you give people access to care and address their blood pressure, they have better blood pressure,” said cardiologist Nieca Goldberg, MD, clinical associate professor of medicine at NYU Grossman School of Medicine, New York City. “We need to look at the overall healthcare system and address why it is we can’t get enough healthcare practitioners into the system to address the basic, common, chronic diseases we see in primary care, like heart disease and hypertension.”

Jiajun Luo, PhD, a postdoctoral fellow at the University of Chicago’s Institute for Population and Precision Health, and first author of the study, said her group hopes to look at the “downstream effect” of improvements in blood pressure — including a lower risk of cardiovascular disease — in future research.

The study was supported by the National Institutes of Health Office of the Directors and National Institute of Environmental Health Sciences. Aschebrook-Kilfoy and Luo have disclosed no relevant financial relationships. Goldberg reported working as the medical director of Atria New York.

Circ Cardiovasc Qual Outcomes. 2022;15:e008845. Abstract

Olivia Dimmer is a Chicago-based journalist.

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