title: Racial disparities in blood pressure control and treatment differences in a Medicaid population, North Carolina, 2005-2006.
abstract: BACKGROUND
  Racial disparities in prevalence and control of high blood pressure are well-documented. We studied blood pressure control and interventions received during the course of a year in a sample of black and white Medicaid recipients with high blood pressure and examined patient, provider, and treatment characteristics as potential explanatory factors for racial disparities in blood pressure control.
  
  
  METHODS
  We retrospectively reviewed the charts of 2,078 black and 1,436 white North Carolina Medicaid recipients who had high blood pressure managed in primary care practices from July 2005 through June 2006. Documented provider responses to high blood pressure during office visits during the prior year were reviewed.
  
  
  RESULTS
  Blacks were less likely than whites to have blood pressure at goal (43.6% compared with 50.9%, P = .001). Blacks above goal were more likely than whites above goal to have been prescribed 4 or more antihypertensive drug classes (24.7% compared with 13.4%, P < .001); to have had medication adjusted during the prior year (46.7% compared with 40.4%, P = .02); and to have a documented provider response to high blood pressure during office visits (35.7% compared with 30.0% of visits, P = .02). Many blacks (28.0%) and whites (34.3%) with blood pressure above goal had fewer than 2 antihypertensive drug classes prescribed.
  
  
  CONCLUSIONS
  In this population with Medicaid coverage and access to primary care, blacks were less likely than whites to have their blood pressure controlled. Blacks received more frequent intervention and had greater use of combination antihypertensive therapy. Care patterns observed in the usual management of high blood pressure were not sufficient to achieve treatment goals or eliminate disparities.
authors.affiliation: Public Health Preparedness Program, Division of Public Health, 1 West Wilson St, Madison, WI 53703, USA. diane.downie@wi.gov
authors.forename: Diane L
authors.initials: DL
authors.lastname: Downie
authors.forename: Dorothee
authors.initials: D
authors.lastname: Schmid
authors.forename: Marcus G
authors.initials: MG
authors.lastname: Plescia
authors.forename: Sara L
authors.initials: SL
authors.lastname: Huston
authors.forename: Susan
authors.initials: S
authors.lastname: Bostrom
authors.forename: Angie
authors.initials: A
authors.lastname: Yow
authors.forename: William W
authors.initials: WW
authors.lastname: Lawrence
authors.forename: C Annette
authors.initials: CA
authors.lastname: DuBard
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D044383:Black People / Q000706:statistics & numerical data*; D001794:Blood Pressure / Q000502:physiology*; D005260:Female; D006302:Health Services Research; D054625:Healthcare Disparities; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000208:ethnology*; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D009657:North Carolina; D012189:Retrospective Studies; D014481:United States; D044465:White People / Q000706:statistics & numerical data*; D055815:Young Adult; D001741:Black or African American
chemical_list: D000959:Antihypertensive Agents