Prevalence, diagnosis gap, and treatment patterns of hypertension in a primary care electronic health record cohort in Qatar: a retrospective cross-sectional study

Hypertension is a major global public health concern and a leading contributor to cardiovascular and renal morbidity and mortality. In Qatar, diverse expatriate populations constitute a large proportion of Primary Health Care Corporation (PHCC) service users, yet evidence on nationality- and region-specific hypertension burden and care gaps in primary care remains limited. This study aimed to estimate hypertension prevalence and assess disparities in diagnosis and treatment by nationality and World Health Organization (WHO) region. A retrospective cross-sectional study was conducted using electronic health record (EHR) data from the Primary Health Care Corporation (PHCC) in Qatar. Adults aged ≥ 18 years with sufficient blood pressure data to derive a reliable summary measure (defined as the median of the most recent three readings) were included. Hypertension was defined using a composite operational definition incorporating blood pressure measurements, recorded diagnosis, and antihypertensive medication use. Undiagnosed hypertension was defined as elevated blood pressure without a recorded diagnosis, and absence of recorded treatment was defined as no antihypertensive prescription documented during the study period among individuals meeting hypertension criteria. Multivariable logistic regression was used to identify associated factors. Among 1,006,122 registered adults, 644,055 with sufficient blood pressure data were included. Mean age was 39.9 ± 13.6 years, and 53.3% were female. Overall hypertension prevalence was 26.0% in the analytic cohort. Among individuals meeting hypertension criteria, 70.2% had no recorded antihypertensive prescription during the study period, while 29.8% had at least one recorded prescription. Undiagnosed hypertension was observed in 8.3% of individuals meeting hypertension criteria. Hypertension prevalence varied across nationality groups (22.5% in Qataris to 36.7% in Filipinos) and WHO regions (23.6% in the Eastern Mediterranean Region vs. 36.2% in the Western Pacific Region). Increasing age and cardiometabolic comorbidities were strongly associated with hypertension. Hypertension remains common in this large primary care EHR cohort, with substantial proportions of individuals lacking recorded diagnosis or treatment. These findings should be interpreted in the context of EHR-based data capture and may reflect gaps in documentation as well as care. Strengthening hypertension identification and management within routine primary care settings may improve cardiovascular risk reduction.