title: Racial differences in blood pressure control: potential explanatory factors.
abstract: OBJECTIVE
  Poor blood pressure control remains a common problem that contributes to significant cardiovascular morbidity and mortality, particularly among African Americans. We explored antihypertensive medication adherence and other factors that may explain racial differences in blood pressure control.
  
  
  METHODS
  Baseline data were obtained from the Veteran's Study to Improve The Control of Hypertension, a randomized controlled trial designed to improve blood pressure control. Clinical, demographic, and psychosocial factors relating to blood pressure control were examined.
  
  
  RESULTS
  A total of 569 patients who were African American (41%) or white (59%) were enrolled in the study. African Americans were more likely to have inadequate baseline blood pressure control than whites (63% vs 50%; odds ratio = 1.70; 95% confidence interval [CI] 1.20-2.41). Among 20 factors related to blood pressure control, African Americans also had a higher odds ratio of being nonadherent to their medication, being more functionally illiterate, and having a family member with hypertension compared with whites. Compared with whites, African Americans also were more likely to perceive high blood pressure as serious and to experience the side effect of increased urination compared with whites. Adjusting for these differences reduced the odds ratio of African Americans having adequate blood pressure control to 1.59 (95% confidence interval 1.09-2.29).
  
  
  CONCLUSIONS
  In this sample of hypertensive patients who have good access to health care and medication benefits, African Americans continued to have lower levels of blood pressure control despite considering more than 20 factors related to blood pressure control. Interventions designed to improve medication adherence need to take race into account. Patients' self-reports of failure to take medications provide an opportunity for clinicians to explore reasons for medication nonadherence, thereby improving adherence and potentially blood pressure control.
authors.affiliation: Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC 27705, USA. hboswort@acpub.duke.edu
authors.forename: Hayden B
authors.initials: HB
authors.lastname: Bosworth
authors.forename: Tara
authors.initials: T
authors.lastname: Dudley
authors.forename: Maren K
authors.initials: MK
authors.lastname: Olsen
authors.forename: Corrine I
authors.initials: CI
authors.lastname: Voils
authors.forename: Benjamin
authors.initials: B
authors.lastname: Powers
authors.forename: Mary K
authors.initials: MK
authors.lastname: Goldstein
authors.forename: Eugene Z
authors.initials: EZ
authors.lastname: Oddone
mesh_terms: D001741:Black or African American; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001294:Attitude to Health; D001794:Blood Pressure; D004522:Educational Status; D005260:Female; D015438:Health Behavior; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000208:ethnology* / Q000503:physiopathology / Q000523:psychology; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000208:ethnology*; D016032:Randomized Controlled Trials as Topic; D014481:United States; D044465:White People
chemical_list: D000959:Antihypertensive Agents