{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T17:49:03Z","timestamp":1790704143804,"version":"4.1.0"},"reference-count":40,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2021,4,30]],"date-time":"2021-04-30T00:00:00Z","timestamp":1619740800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000050","name":"NHLBI","doi-asserted-by":"publisher","award":["R01HL136575"],"award-info":[{"award-number":["R01HL136575"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["R01CA204267"],"award-info":[{"award-number":["R01CA204267"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,9,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The Affordable Care Act (ACA) Medicaid expansion improved access to health insurance and health care services. This study assessed whether the rate of patients with undiagnosed hypertension and the rate of patients with hypertension without anti-hypertensive medication decreased post-ACA in community health center (CHC).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We analyzed electronic health record data from 2012 to 2017 for 126,699 CHC patients aged 19\u201364 years with \u22651 visit pre-ACA and \u22651 post-ACA in 14 Medicaid expansion states. We estimated the prevalence of patients with undiagnosed hypertension (high blood pressure reading without a diagnosis for \u22651 day) and the prevalence of patients with hypertension without anti-hypertensive medication by year and health insurance type (continuously uninsured, continuously insured, gained insurance, and discontinuously insured). We compared the time to diagnosis or to anti-hypertensive medication pre- vs. post-ACA.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Overall, 37.3% of patients had undiagnosed hypertension and 27.0% of patients with diagnosed hypertension were without a prescribed anti-hypertensive medication for \u22651 day during the study period. The rate of undiagnosed hypertension decreased from 2012 through 2017. Those who gained insurance had the lowest rates of undiagnosed hypertension (2012: 14.8%; 2017: 6.1%). Patients with hypertension were also more likely to receive anti-hypertension medication during this period, especially uninsured patients who experienced the largest decline (from 47.0% to 8.1%). Post-ACA, among patients with undiagnosed hypertension, time to diagnosis was shorter for those who gained insurance than other insurance types.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Those who gained health insurance were appropriately diagnosed with hypertension faster and more frequently post-ACA than those with other insurance types.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Clinical trials registration<\/jats:title>\n                  <jats:p>Trial Number NCT03545763.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ajh\/hpab069","type":"journal-article","created":{"date-parts":[[2021,4,28]],"date-time":"2021-04-28T19:12:54Z","timestamp":1619637174000},"page":"989-998","source":"Crossref","is-referenced-by-count":38,"title":["Rates of Undiagnosed Hypertension and Diagnosed Hypertension Without Anti-hypertensive Medication Following the Affordable Care Act"],"prefix":"10.1093","volume":"34","author":[{"given":"Nathalie","family":"Huguet","sequence":"first","affiliation":[{"name":"Department of Family Medicine, Oregon Health and Science University , Portland, Oregon , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annie","family":"Larson","sequence":"additional","affiliation":[{"name":"Research Department, OCHIN Inc. , Portland, Oregon , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather","family":"Angier","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Oregon Health and Science University , Portland, Oregon , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0066-4478","authenticated-orcid":false,"given":"Miguel","family":"Marino","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Oregon Health and Science University , Portland, Oregon , USA"},{"name":"Biostatistics Group, Oregon Health and Science University\u2014Portland State University School of Public Health , Portland, Oregon , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beverly B","family":"Green","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Washington Health Research Institute , Seattle, Washington , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2974-9544","authenticated-orcid":false,"given":"Laura","family":"Moreno","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Oregon Health and Science University , Portland, Oregon , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer E","family":"DeVoe","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Oregon Health and Science University , Portland, Oregon , 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