Rural-Urban Differences in Hypertension Prevalence and Control in a Large Regional Health System Cohort

Authors

• Yordanos M Tiruneh
• Susan McBride
• Huaxin Song
• Matthew Decaro
• Alaa Rihan
• Theresa Byrd
• Alex Baham
• Jared W Magnani
• Elmer V Bernstam
• Jarett D Berry

Language

English

Publication Date

5-30-2026

Journal

Journal of Clinical Medicine

DOI

10.3390/jcm15114233

PMID

42279094

PMCID

PMC13258278

PubMedCentral® Posted Date

5-30-2026

PubMedCentral® Full Text Version

Post-print

Abstract

Background: Rural US populations bear a high burden of cardiovascular disease, with hypertension contributing to the rural-urban gap. We examined hypertension prevalence and control across the rural-urban continuum among patients in a large healthcare system in Northeast Texas.

Methods: We analyzed the electronic health record data from 363,539 patients with at least one outpatient encounter between September 2021 and April 2025. We defined hypertension using ICD-10-CM codes, antihypertensive prescriptions, or a blood pressure ≥ 130/80 mm Hg. We classified rurality using the Rural-Urban Commuting Area categories. Multivariable logistic regression models were adjusted for age, sex, race, ethnicity, insurance, and level of engagement with the healthcare system.

Results: Compared with metropolitan areas, micropolitan residents had lower odds of hypertension (OR = 0.85). We found uncontrolled hypertension also to be more common in metropolitan areas, with a lower prevalence observed across non-metropolitan categories, particularly among isolated rural residents (OR = 0.82). Black patients exhibited higher rates of uncontrolled hypertension across all rural-urban categories. Continuity of care was associated with hypertension prevalence but not control.

Conclusions: Hypertension prevalence and control vary across the rural-urban continuum in Northeast Texas, with consistent differences observed between metropolitan and some non-metropolitan residents. Persistent racial differences across all geographic settings support the need for targeted prevention and management strategies.

Keywords

hypertension, rural health, rural–urban differences, blood pressure control, cardiovascular disease prevention, Texas

Published Open-Access

yes

Recommended Citation

Tiruneh, Yordanos M; McBride, Susan; Song, Huaxin; et al., "Rural-Urban Differences in Hypertension Prevalence and Control in a Large Regional Health System Cohort" (2026). Faculty, Staff and Student Publications. 822.
https://digitalcommons.library.tmc.edu/uthshis_docs/822