Understanding contributors to racial disparities in blood pressure control.
BACKGROUND
Racial disparities in blood pressure (BP) control are well documented but poorly understood; prior studies have only included a limited range of potential explanatory factors. We examined a comprehensive set of putative factors related to blood pressure control, including patient clinical and sociodemographic characteristics, beliefs about BP and BP medications, medication adherence, and experiences of discrimination, to determine if the impact of race on BP control remains after accounting for such factors.


RESULTS
We recruited 806 white and black patients with hypertension from an urban safety-net hospital. From a questionnaire administered to patients after their clinic visits, electronic medical record and BP data, we assessed an array of patient factors. We then examined the association of patient factors with BP control by modeling it as a function of the covariates using random-effects logistic regression. Blacks indicated worse medication adherence, more discrimination, and more concerns about high BP and BP medications, compared with whites. After accounting for all factors, race was no longer a significant predictor of BP control.


CONCLUSIONS
Results suggest that equalizing patients' health beliefs, medication adherence, and experiences with care could ameliorate disparities in BP control. Additional attention must focus on the factors associated with race to identify, and ultimately intervene on, the causes of racial disparities in BP outcomes.
Section of General Internal Medicine, Boston University School of Medicine, Boston, MA 02118, USA. nkressin@bu.edu
Nancy R
NR
Kressin
Michelle B
MB
Orner
Meredith
M
Manze
Mark E
ME
Glickman
Dan
D
Berlowitz
D001741:Black or African American / Q000523:psychology / Q000706:statistics & numerical data; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D016009:Chi-Square Distribution; D003466:Cultural Characteristics; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000208:ethnology / Q000503:physiopathology / Q000523:psychology; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D016017:Odds Ratio; D010465:Perception; D011287:Prejudice; D018570:Risk Assessment; D012307:Risk Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D044465:White People / Q000523:psychology / Q000706:statistics & numerical data
D000959:Antihypertensive Agents