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Determinants of racial/ethnic differences in blood pressure management among hypertensive patients
LeRoi S Hicks1, Shimon Shaykevich, David W Bates
1Division of General Internal Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA. hicks@hcp.med.harvard.edu
Insights
Racial and ethnic disparities in hypertension treatment intensification were explained by differences in clinic visit frequency and diabetes prevalence. Future interventions should address these factors to reduce cardiovascular outcome disparities.
Area of Science:
- Internal Medicine
- Cardiovascular Health
- Health Disparities
Background:
- Previous studies indicate racial/ethnic minorities with hypertension may receive less aggressive treatment.
- Limited data exist on confounders of racial/ethnic disparities in hypertension treatment intensity.
Purpose of the Study:
- To investigate racial/ethnic disparities in the intensity of hypertension treatment.
- To identify confounders associated with these disparities in treatment intensification.
Main Methods:
- Retrospective review of medical records for 1,205 patients with hypertension.
- Logistic regression analysis to determine odds of therapy intensification by race/ethnicity, adjusting for clinical factors.
Main Results:
- Blacks (81.9%) and Whites (80.3%) were more likely than Latinos (71.5%) to have therapy intensified (P = 0.03).
- After adjusting for outpatient visit frequency and diabetes, no significant racial differences in treatment intensification rates were observed.
Conclusions:
- Racial/ethnic differences in hypertension treatment intensification are largely explained by variations in clinic visit frequency and diabetes prevalence.
- Interventions should enhance physician awareness for more aggressive drug therapy intensification, especially in patients with fewer visits and among diabetic individuals, to reduce cardiovascular disparities.
Background:
Prior literature has shown that racial/ethnic minorities with hypertension may receive less aggressive treatment for their high blood pressure. However, to date there are few data available regarding the confounders of racial/ethnic disparities in the intensity of hypertension treatment.
Methods:
We reviewed the medical records of 1,205 patients who had a minimum of two hypertension-related outpatient visits to 12 general internal medicine clinics during 7/1/01-6/30/02. Using logistic regression, we determined the odds of having therapy intensified by patient race/ethnicity after adjustment for clinical characteristics.
Results:
Blacks (81.9%) and Whites (80.3%) were more likely than Latinos (71.5%) to have therapy intensified (P = 0.03). After adjustment for racial differences in the number of outpatient visits and presence of diabetes, there were no racial differences in rates of intensification.
Conclusion:
We found that racial/ethnic differences in therapy intensification were largely accounted for by differences in frequency of clinic visits and in the prevalence of diabetes. Given the higher rates of diabetes and hypertension related mortality among Hispanics in the U.S., future interventions to reduce disparities in cardiovascular outcomes should increase physician awareness of the need to intensify drug therapy more agressively in patients without waiting for multiple clinic visits, and should remind providers to treat hypertension more aggressively among diabetic patients.
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