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The Edgecombe County High Blood Pressure Control Program: the process of medical care and blood pressure control
D J Ballard1, D S Strogatz, E H Wagner
1Department of Medical Statistics and Epidemiology, Mayo Clinic, Rochester, MN 55905.
Insights
Aggressive antihypertensive drug therapy improved blood pressure control, particularly for Black patients. Physician treatment aggressiveness significantly impacted hypertension management outcomes across racial and sex groups.
Area of Science:
- Cardiovascular Medicine
- Public Health
- Health Disparities
Background:
- Hypertension remains a significant public health concern, with documented disparities in control rates across racial and sex demographics.
- Effective management of high blood pressure (hypertension) is crucial for preventing cardiovascular complications.
Purpose of the Study:
- To examine the association between the process of medical care and blood pressure control in a county-based program.
- To investigate racial and sexual variations in the level and impact of medical care for hypertension.
Main Methods:
- A medical record review was conducted within a multispecialty private group practice.
- Data from 628 hypertensive patients over a three-year period were analyzed.
- Blood pressure control was assessed using Hypertension Detection and Follow-up Program criteria.
Main Results:
- 41% of hypertensive patients had uncontrolled diastolic blood pressure (DBP) after three years.
- Uncontrolled hypertension rates varied significantly by race and sex, from 53% in Black men to 34% in white women.
- Patients whose physicians used more aggressive antihypertensive drug therapy were more likely to achieve blood pressure control.
Conclusions:
- Physician aggressiveness in drug therapy is linked to better hypertension control.
- The impact of aggressive treatment appeared more pronounced in Black patients, suggesting potential racial disparities in treatment efficacy or exposure.
- Racial differences in the utilization and effectiveness of aggressive antihypertensive strategies may contribute to observed variations in blood pressure control.
Abstract:
As part of the Edgecombe County High Blood Pressure Control Program, a medical record review was conducted within a multispecialty private group practice in the county. The purposes of the review were to assess the relationship between the process of medical care and blood pressure control and to explore the variation in level and impact of medical care by race and sex. At the end of a three-year period, 41 percent of 628 hypertensive patients from the practice had uncontrolled diastolic blood pressure (DBP), as defined by Hypertension Detection and Follow-up Program criteria. The percentage of uncontrolled hypertensives ranged from 53 percent for black men to 34 percent for white women. Hypertensive patients whose physicians were more aggressive in their use of antihypertensive drug therapy were more likely to be controlled. The effect of the level of physician drug aggressiveness tended to be more pronounced for blacks than for whites. Differences by race in exposure to and efficacy of aggressive drug treatment may influence racial variation in blood pressure control.