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Determinants of uncontrolled hypertension in an African-American population
James H Jackson1, Thomas J Bramley, Tina H Chiang
1Applied Health Outcomes, Division of Navigant Consulting, Inc., Tampa, Florida 33609, USA. jjackson@applied-outcomes.com
Insights
Blood pressure control is low in African Americans, especially those with diabetes. Aggressive treatment for this high-risk group could lower complications and mortality.
Area of Science:
- Cardiology
- Public Health
- Health Disparities
Background:
- Hypertension affects a significant portion of the African-American population.
- Achieving blood pressure control is crucial for preventing cardiovascular disease complications.
- Existing data on blood pressure control and its determinants in African Americans is limited.
Purpose of the Study:
- To evaluate blood pressure control rates among African-American patients with hypertension.
- To identify key factors associated with uncontrolled blood pressure in this demographic.
Main Methods:
- A retrospective analysis of clinical data from a nationwide hypertension quality improvement initiative.
- Logistic regression was used to determine the association between various clinical variables and uncontrolled blood pressure.
- Data was sourced from pharmacy and medical claims, with a subset undergoing chart review.
Main Results:
- Approximately 64% of African-American patients had uncontrolled hypertension, falling short of the Healthy People 2010 goal.
- Patients with diabetes were significantly more likely (OR = 2.92) to have uncontrolled blood pressure.
- Key patient demographics included 66% female, mean age 60.4 years, 47.8% with dyslipidemia, and 31.4% with diabetes.
Conclusions:
- Blood pressure control remains a significant challenge in the African-American population.
- Diabetes is a major independent risk factor for uncontrolled blood pressure in this group.
- Targeted, aggressive management strategies for hypertensive African Americans, particularly those with diabetes, are recommended to mitigate adverse outcomes.
Objectives:
The purpose of this study was to assess blood pressure control and the determinants of uncontrolled blood pressure among African-American hypertensive patients.
Design:
Baseline clinical data were collected as part of a nationwide hypertension quality improvement initiative. An analysis of determinants of uncontrolled blood pressure was conducted using logistic regression for the following variables: angina, congestive heart failure, coronary artery disease, diabetes, family history of cardiovascular disease or stroke, hyperlipidemia, left ventricular hypertrophy, and tobacco use.
Setting:
10 managed care/advanced physician organizations.
Patients:
Pharmacy and medical claims covering 1,965,000 lives were reviewed and 292,996 members with a hypertension-related claim were identified between June 1, 1998 and July 1, 2001. A random sample (N = 5,935) was selected for chart review. The present analysis was conducted on the subset of African-American patients (N = 440) included in this sample.
Results:
Approximately 66% of the African-American patients were female, the mean age was 60.4 years, 47.8% had dyslipidemia, and 31.4% had diabetes. Approximately 64% had uncontrolled hypertension. Patients with diabetes were 3 times more likely to have uncontrolled blood pressure as were patients without diabetes (OR = 2.92; P < .0001).
Conclusions:
Blood pressure control in the African-American population is lower than the Healthy People 2010 goal of 50%. African Americans with hypertension and diabetes are at an increased risk for uncontrolled blood pressure. Treating this high-risk population more aggressively may reduce long-term complications and decrease mortality.