title: Racial and ethnic differences in longitudinal blood pressure control in veterans with type 2 diabetes mellitus.
abstract: BACKGROUND
  Few studies have examined racial/ethnic differences in blood pressure (BP) control over time, especially in an equal access system. We examined racial/ethnic differences in longitudinal BP control in Veterans with type 2 diabetes.
  
  
  METHODS
  We collected data on a retrospective cohort of 5,319 Veterans with type 2 diabetes and initially uncontrolled BP followed from 1996 to 2006 at a Veterans Administration (VA) facility in the southeastern United States. The mean blood pressure value for each subject for each year was used for the analysis with BP control defined as <140/<90 mmHg. The primary outcome measure was proportion with controlled BP. The main predictor variable was race/ethnicity categorized as non-Hispanic White (NHW), non-Hispanic Black (NHB), or Hispanic/Other (H/O). Other covariates included age, gender, employment, marital status, service connectedness, and ICD-9 coded medical and psychiatric comorbidities. Generalized linear mixed models were used to assess the relationship between race/ethnicity and BP control after adjusting for covariates.
  
  
  RESULTS
  Mean follow-up was 5.0 years. The sample was 46% NHW, 26% NHB, 19% H/O, and 9% unknown. The average age was 68 years. In the final model, after adjusting for covariates, NHB race (OR = 1.38, 95%CI: 1.2, 1.6) and H/O race (OR = 1.57, 95% CI: 1.3, 1.8) were associated with increased likelihood of poor BP control (>140/>90 mmHg) over time compared to NHW patients.
  
  
  CONCLUSIONS
  Ethnic minority Veterans with type 2 diabetes have significantly increased odds of poor BP control over ∼5 years of follow-up compared to their non-Hispanic White counterparts independent of sociodemographic factors and comorbidity patterns.
authors.affiliation: Center for Disease Prevention and Health Interventions for Diverse Populations, Ralph H. Johnson VAMC, Charleston, SC, USA.
authors.forename: R Neal
authors.initials: RN
authors.lastname: Axon
authors.forename: Mulugeta
authors.initials: M
authors.lastname: Gebregziabher
authors.forename: Carrae
authors.initials: C
authors.lastname: Echols
authors.forename: Gregory Gilbert
authors.initials: GG
authors.lastname: Msph
authors.forename: Leonard E
authors.initials: LE
authors.lastname: Egede
mesh_terms: D000368:Aged; D001794:Blood Pressure; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000208:ethnology* / Q000473:pathology; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000208:ethnology / Q000517:prevention & control*; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D044469:Racial Groups / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000706:statistics & numerical data*