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Racial disparities in hypertension control, but not treatment intensification

Craig A Umscheid1, Robert Gross, Mark G Weiner

  • 1Division of General Internal Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.

American Journal of Hypertension
|November 7, 2009
PubMed

Insights

Black patients experience worse hypertension control. Providers were more likely to intensify antihypertensive drug treatment for Black patients with uncontrolled hypertension, suggesting appropriate management.

Area of Science:

  • Health Services Research
  • Clinical Practice
  • Health Disparities

Background:

  • Racial disparities in hypertension control are a significant public health concern.
  • The role of healthcare providers in perpetuating these disparities requires further investigation.

Purpose of the Study:

  • To investigate whether healthcare provider management of uncontrolled hypertension differs based on patient race.
  • To analyze provider treatment intensification patterns for Black versus White patients with uncontrolled hypertension.

Main Methods:

  • A retrospective cohort study of 16,881 adult patients with hypertension across six academic primary care practices (2004-2006).
  • Evaluation of hypertension control using expert guidelines and analysis of antihypertensive drug intensification for uncontrolled cases.
  • Generalized estimating equations were used to adjust for patient, provider, and practice characteristics.

Main Results:

  • Black patients had a higher prevalence of uncontrolled hypertension (adjusted odds ratio 1.40).
  • Antihypertensive drug intensification was less likely for Black patients initially but moderated after full adjustment (adjusted odds ratio 0.93).
  • When provider race was considered, intensification was more likely during visits with Black patients compared to White patients.

Conclusions:

  • Black patients exhibited poorer hypertension control compared to White patients.
  • Providers were more likely to intensify antihypertensive medications for Black patients with uncontrolled hypertension, indicating appropriate management.
  • Further research is necessary to fully elucidate the complex factors contributing to racial disparities in hypertension control.
Abstract

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