We evaluated the prevalence, awareness, treatment, and control of hypertension (defined as a systolic blood pressure [BP]) ≥140 mm Hg, diastolic BP ≥90 mm Hg, or a self-reported use of an antihypertensive agent) among US adults, stratified by race/ethnicity. This analysis included 16 531 nonpregnant US adults (≥18 years) in the three National Health and Nutrition Examination Survey cycles between 2013 and 2018. Race/ethnicity was defined by self-report as White, Black, Hispanic, Asian, or other Americans. Among 76 910 050 (74 449 985–79 370 115) US adults with hypertension, 48.6% (47.3%–49.8%, unadjusted) have controlled BP. When compared with BP control rates for White adults (49.0% [46.8%–51.2%], age-adjusted), BP control rates are lower in Black (39.2%, adjusted odds ratio [aOR], 0.71 [95% CI, 0.59–0.85], P <0.001), Hispanic (40.0%, aOR, 0.71 [95% CI, 0.58–0.88], P =0.003), and Asian (37.8%, aOR, 0.68 [95% CI, 0.55–0.84], P =0.001) Americans. Black adults have higher hypertension prevalence (45.3% versus 31.4%, aOR, 2.24 [95% CI, 1.97–2.56], P <0.001) but similar awareness and treatment rates as White adults. Hispanic adults have similar hypertension prevalence, but lower awareness (71.1% versus 79.1%, aOR, 0.72 [95% CI, 0.58–0.89], P =0.005) and treatment rates (60.5% versus 67.3%, aOR, 0.78 [95% CI, 0.66–0.94], P =0.010) than White adults. Asian adults have similar hypertension prevalence, lower awareness (72.5% versus 79.1%, aOR, 0.75 [95% CI, 0.58–0.97], P =0.038) but similar treatment rates. Black, Hispanic, and Asian Americans have different vulnerabilities in the hypertension control cascade of prevalence, awareness, treatment, and control. These differences can inform targeted public health efforts to promote health equity and reduce the burden of hypertension in the United States.

Over the last decade, the Centers for Medicare & Medicaid Services (CMS) has implemented national value-based payment programs that aim to incentivize hospitals to deliver higher quality of care. Black adults face systemic barriers in health care access and often receive care at a limited set of underresourced hospitals. 1 Although recent changes have been made to some value-based programs to reduce the burden of penalties on safety-net hospitals that serve low-income patients, 2-4 whether these initiatives disparately affect hospitals that care for a high proportion of Black patients remains unclear.Therefore, we evaluated whether hospitals that care for a high proportion of Black patients are more likely than other hospitals to be penalized by value-based programs.Methods | We identified all hospitals that participated in the Hospital Value-Based Purchasing Program (HVBP), Hospital Readmission Reduction Program (HRRP), or Hospital-Acquired Condition Reduction Program (HACRP) in fiscal year 2019 (eAppendix in the Supplement). 3 To identify hospitals' penalty-bonus status and the magnitude of these payment adjustments under each program, we used CMS Hospital Compare. We determined the proportion of Medicare hospitalizations for Black patients using MedPAR files (2015)(2016)(2017)(2018)-institutions in the highest quintile were categorized as high-proportion Black hospitals. The American Hospital Association and CMS Impact Files (2018) were used to determine hospitals' characteristics and safety-net status (eAppendix in the Supplement).We calculated the proportion of high-proportion Black hospitals and other hospitals that received a penalty (or bonus) under each value-based payment program. We then determined the adjusted difference between these proportions using multivariable logistic regression, adjusting for hospital characteristics (bed size, teaching status, urban vs rural) and safety-net status. The mean payment adjustment was also determined. Comparisons were performed using 2-sided t tests or χ 2 tests. A 2-sided P < .05 defined statistical significance. Analyses were performed using R version 3.5.2. Institutional review board approval was not required by Beth Israel Deaconess Medical Center because the study used publicly available data. Table. Value-Based Payment Adjustments for Hospitals With a High Proportion of Black Patients vs Other Hospitals Total No. of hospitals High-proportion Black hospitals Other hospitals % (95% CI) Difference Adjusted difference a Hospital Value-Based Purchasing Program No. 2786 544 2242 Received penalty, No. (%) 1229 (44.1) 303 (55.7) 926 (41.3) 14.4 (9.8 to 19.0) 8.0 (2.9 to 13.2) Received bonus, No. (%) 1557 (55.9) 241 (44.3) 1316 (58.7) −14.4 (−19.0 to −9.8) −8.0 (−13.2 to −2.9