Disparities/Minority Health

Racial/ethnic disparities found in management of patients with high blood pressure

Blood pressure control is poorest among racial/ethnic minorities and diabetes patients. Yet, Hispanics are less likely than blacks and whites to have their antihypertensive therapy intensified to improve blood pressure control, according to a study supported in part by the Agency for Healthcare Research and Quality (HS11046). Blood pressure was controlled most often among whites (39 percent), followed by blacks (35 percent) and Hispanics (33 percent). Blacks (82 percent) and whites (81 percent) were more likely than Hispanics (71 percent) to have therapy intensified (increasing the dose or adding another medication) for better control.

After adjustment for baseline blood pressure, intensifying therapy was associated with 55 percent higher odds of subsequent blood pressure control (odds ratio, OR 1.55), regardless of patient race/ethnicity. This suggests that equally aggressive management of hypertension might overcome any biological mechanisms that may contribute to racial differences in blood pressure outcomes, explains LeRoi Hicks, M.D., M.P.H., of Brigham and Women's Hospital and Harvard Medical School.

The researchers also found that patients with diabetes were 55 percent less likely (OR 0.45) than those without diabetes to have their blood pressure controlled to the recommended level. Diuretics were the most commonly prescribed medication (45 percent) followed by beta-blockers (44 percent), angiotensin-converting enzyme (ACE) inhibitors (39 percent), calcium channel blockers (27 percent), and angiotensin-receptor blockers (9 percent). These findings are based on a review of medical records of 9,601 patients with 15,768 hypertension-related outpatient visits to 12 general medicine clinics in 2001 and 2002. The goal of the study was to determine whether hypertension management guidelines were followed during the visits.

See "Determinants of JNC VI guideline adherence, intensity of drug therapy, and blood pressure control by race and ethnicity," by Dr. Hicks, David G. Fairchild, Mark S. Horng, and others in the October 2004 Hypertension 44, pp. 429-434.

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