Determinants of racial/ethnic differences in blood pressure management among hypertensive patients.
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.


CONCLUSIONS
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.
Division of General Internal Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA. hicks@hcp.med.harvard.edu
LeRoi S
LS
Hicks
Shimon
S
Shaykevich
David W
DW
Bates
John Z
JZ
Ayanian
D001741:Black or African American; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000208:ethnology; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology / Q000208:ethnology; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009819:Office Visits; D015995:Prevalence; D011787:Quality of Health Care / Q000639:trends*; D014481:United States / Q000453:epidemiology; D044465:White People
D000959:Antihypertensive Agents