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Objectives: Control of hypertension has improved nationally with focus on identifying and treating elevated blood pressures (BP) to guideline recommended levels. However, once BP control is achieved, the frequency in which BP falls out of control and the factors associated with BP recidivism is unknown. The objective of this study is to examine rates and predictors of blood pressure recidivism in adults with controlled hypertension. Study Design: A retrospective cohort study in two large, integrated health care systems in Minnesota and Colorado. Methods: Patients with a prior diagnosis of hypertension based on a combination of ICD-9 codes, receipt of anti-hypertensive medications and/or elevated blood pressure readings were eligible to be included. We defined controlled hypertension as normotensive blood pressure (BP) readings (less than 140/90 mmHg or less than 130/80 mmHg if coexistent diabetes or chronic kidney disease present) at 2 consecutive primary care visits. Following these visits among patients with controlled BP, we followed patients for BP recidivism defined by the mean of the last 2 blood pressure readings greater than 140/90 mm Hg or 130/80 mm Hg for those with diabetes or chronic kidney disease during a mean follow-up period of 13.2 months . Results: A total of 22,275 patients with controlled hypertension were included in this study. The proportion of patients with hypertension recidivism was 16.4%. A linear increase in blood pressure recidivism was noted with time between the index visit and last observed blood pressure reading. Major predictors of recidivism included female gender (OR 1.14, p = 0.02), history of diabetes (OR 2.32, p < 0.001) and black race (OR 1.37, p = 0.02). Age 50-64 displayed a protective effect against recidivism (OR 0.80, p = 0.02). Conclusions: Hypertensive recidivism occurs in a significant portion of patients with controlled hypertension. Patient factors associated with recidivism include age, race and prior history of diabetes among other characteristics. Strategies to minimize hypertension recidivism have significant potential to improve overall levels of blood pressure control and hypertension related quality measures from a health care systems perspective.