title: Understanding racial disparities in treatment intensification for hypertension management.
abstract: BACKGROUND
  Disparities in blood pressure (BP) control may be a function of disparities in treatment intensification (TI).
  
  
  OBJECTIVE
  To examine racial differences in TI, understand modifiable factors that may mediate this relationship, and explore the relative effects of TI and race on blood pressure.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Participants were 819 black and white patients with hypertension from an urban, safety-net hospital
  
  
  METHODS
  We sequentially explored the effects of patient race, sociodemographic and clinical characteristics, beliefs about BP/medications, perceptions of provider/discrimination, sodium intake, medication adherence, and provider counseling on TI, performing a series of random effects analyses. To assess the effects of race and TI on BP, we performed linear regressions, using systolic BP (SBP) as the outcome.
  
  
  RESULTS
  Unadjusted analyses and those including sociodemographic and clinical characteristics revealed that black patients had less TI than whites (-0.31 vs.-0.24, p < 0.001), but adjustment for patient beliefs and experiences eliminated the effects of race (beta =-0.02, p = 0.5). Increased patient concerns about BP medications were related to lower TI, as was more provider counseling (beta =-0.06, p = 0.02 and beta = -0.01, p = 0.001, respectively). In the unadjusted analysis, black race was a significant predictor of SBP (134 mm/Hg for blacks vs. 131 mm/Hg for whites, p = 0.009), but when both race and TI were included in the model, TI was a significant predictor of SBP (final SBP 2.0 mm/Hg lower for each additional therapy increase per 10 visits, p < 0.001), while race was not (Blacks 1.6 mm/Hg higher than whites, p = 0.17).
  
  
  CONCLUSIONS
  Improved patient-provider communication targeted towards addressing patient concerns about medications may have the potential to reduce racial disparities in TI and ultimately, BP control.
authors.affiliation: Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA. meredith.manze@bmc.org
authors.forename: Meredith
authors.initials: M
authors.lastname: Manze
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Rose
authors.forename: Michelle B
authors.initials: MB
authors.lastname: Orner
authors.forename: Dan R
authors.initials: DR
authors.lastname: Berlowitz
authors.forename: Nancy R
authors.initials: NR
authors.lastname: Kressin
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D054625:Healthcare Disparities; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D016014:Linear Models; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D013223:Statistics as Topic; D011795:Surveys and Questionnaires; D044465:White People / Q000706:statistics & numerical data*
chemical_list: D000959:Antihypertensive Agents
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