Racial and Ethnic Differences in Shared Decision Making Among Patients With Hypertension: Results From the RICH...

Racial and ethnic disparities in hypertension care persist. Shared decision making (SDM) is promoted in hypertension guidelines. However, evidence is lacking on how race, ethnicity, and SDM relate, and the effect of SDM on hypertension control in diverse groups. We aimed to explore the relationships among SDM, blood pressure (BP), race and ethnicity, and other decision-making factors in patients with hypertension.

Longitudinal analysis of data from the RICH LIFE (Reducing Inequities in Care of Hypertension: Lifestyle Improvement for Everyone) project's participants (n=1426) with uncontrolled hypertension was performed using descriptive statistics, linear regression, and generalized estimating equations. Participants were middle-aged (mean age 60±11.6 years), predominantly women (59.4%, 847), non-Latino Black (59%, 844), and high school graduates or below (65%, 931). The mean SDM score was 7.2±2.6 out of 9, and the mean baseline systolic and diastolic BP were 152.2±12.0 and 85.3±12.1 mm Hg. Non-Latino Black people had 0.14 points higher mean SDM score (P<0.001) than non-Latino White people. Systolic BP reduction over 12 months was greater with a higher SDM mean score (β=-0.42, P=0.035). Baseline characteristics associated with SDM included more than high school education (β=-0.08, P=0.045), hypertension knowledge (β=-0.05, P=0.046), considering taking BP medication as very important (β=0.06, P=0.022), and patient activation (β=0.09, P=0.001).

There was greater BP reduction for patients with higher SDM score at follow-up, and associations between SDM and race and ethnicity, education, hypertension knowledge and attitude, and patient activation. Future research should further explore SDM differences among racial and ethnic groups to better align hypertension care with patients' needs.