Introduction: Health systems are increasingly leveraging real-world data to improve community health outcomes. Methods: We conducted a longitudinal assessment of health outcomes in patients with severe hypertension using electronic health record data from the Sentara Healthcare System 2010-2021. Severe hypertension was defined as at least two consecutive blood pressure (BP) readings above 160/100 mmHg. We examined follow-up visit rates at 3 and 6 months, and BP control rates (<140/90 mmHg) at 6 and 12 months after the second BP elevation. We also assessed the incidence of cardiovascular disease (CVD) until the end of 2022. Results: The study included 75,657 patients with severe hypertension. Mean age was 61.5 (13.9) years; 55% were female, 57% were White, 37% were Black, and 21.3% had a history of CVD. The median follow-up time was 3.8 years. Among patients with severe hypertension, 72% and 84% had follow-up visits at 3 and 6 months; 38% and 41% achieved BP control at 6 and 12 months. Among patients without prior history of CVD, 22.5% experienced at least one cardiovascular event during the follow-up, including 8.7% with coronary arteriosclerosis, 11.9% with heart failure, 65.2% with cerebral infarction, and 3.5% with myocardial infarction. The median time to cardiovascular events was 793 days. The risk of CVD was significantly higher in Black and older patients, as well as those with blood pressure levels exceeding 180/120 mmHg. Conclusions: This study successfully identified a longitudinal digital cohort of patients with severe hypertension and linked it to health outcomes. The findings have implications for health systems utilizing real-world data in population health research.

Introduction: Timely hypertension diagnosis is vital for effective management and prevention of complications. This study assessed hypertension diagnosis delays in a large regional health system using electronic health records (EHRs). Methods: Retrospective analysis of EHR data (2010-2021) in Sentara Healthcare System was conducted. Hypertension diagnosis was defined as two outpatient blood pressure (BP) readings >=140/90 mmHg within two years, with at least 30 days separation. The delay in diagnosis was determined as the time elapsed from the computable diagnosis to the structured diagnosis documented in the EHR. Results: Among 302,774 patients with computable hypertension diagnosis, 23.6% lacked a structured diagnosis. Furthermore, 23.8% received early structured diagnosis (after first BP elevation), and 18.6% received eventual structured diagnosis (after second BP elevation). Among those who received an eventual structured diagnosis, the median delay in hypertension diagnosis was 21.7 months (interquartile range: 7.5-45.5 months). Prescription rate for antihypertensive medication was significantly lower for patients with no structured diagnosis (44.2%) and eventual structured diagnosis (38.1%) than for those with early structured diagnosis (82.3%). Longer delays were associated with older age, male gender, and Black patients. Conclusions: The study highlights concerning delays in hypertension diagnosis, impacting timely intervention and complication prevention. By leveraging EHR data, health systems can identify areas for improvement and enhance the efficiency of hypertension diagnosis, leading to improved patient outcomes.

![Figure][1] Randomized clinical trials have established that percutaneous coronary intervention (PCI) is the preferred strategy for acute reperfusion in patients with ST-segment elevation myocardial infarction (STEMI) ([1][2]). The time from symptom onset until mechanical reperfusion is a

Cerebrotendinous xanthomatosis (CTX), first described by van Bogaert et al in 1937,1 is a rare (<100 cases reported), autosomal recessive disease characterized by accumulation of cholesterol and cholestanol in tissues. Its clinical features can include tendon xanthomas, cataracts, neurologic dysfunction (dementia, ataxia, paresis and peripheral neuropathy) and accelerated arterial atherosclerosis. CTX results from a deficiency of a hepatic microsomal enzyme necessary for primary bile acid synthesis from cholesterol. Because bile acid synthesis is impaired, chenodeoxycholic acid in bile is reduced or absent, biliary cholesterol secretion is reduced, and, for reasons uncertain, the hepatic conversion of cholesterol to cholestanol is markedly increased and blood, biliary and tissue cholestanol levels are markedly elevated (Figure 1).2,3 Cholestanol appears to be highly atherogenic and has been demonstrated in most tissues, including the coronary arteries.3 Although accelerated coronary atherosclerosis is believed to be characteristic of this lipid disorder, coronary angiographic findings have not been reported in CTX. Herein, we describe such findings.