Determinants of racial/ethnic differences in blood pressure management among hypertensive patients

Hicks, LeRoi S.; Shaykevich, Shimon; Bates, David W.; Ayanian, John Z.

doi:10.1186/1471-2261-5-16

Cited by 27 publications

(33 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…1,[3][4][5]10 This finding has been interpreted as evidence of disparities in treatment and has raised concerns that care agencies have failed to reach this growing segment of the population. …”

Section: Discussionmentioning

confidence: 92%

“…2,3,5 Among the studies that have examined HTN control in primary care settings, few have included minority populations or been conducted in federally qualified community health centers (FQHCs) which reach the most vulnerable populations. 6,[8][9][10] As a result, the prevalence of HTN and correlates of HTN control among low income, minority, and/or immigrant populations who access care in FQHCs is poorly characterized. This study takes advantage of a large office-based dataset derived from four FQHCs to describe the prevalence and correlates of HTN control in an ethnically diverse, low-income population who have regular access to primary care.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Predictors of Blood Pressure Control Among Hypertensives in Community Health Centers

Shelley

Tseng

Andrews

et al. 2011

American Journal of Hypertension

View full text Add to dashboard Cite

Blacks had poorer HTN control compared with whites and Hispanics. Significant discrepancies in BP control between hypertensive patients with and without diabetes may be related to a lack of provider adherence to JNC 7 guidelines that define BP control in this population as <130/80. Further research is needed to understand racial disparities in BP control as well as factors influencing clinician's management of BP among patients with diabetes.

show abstract

Section: Discussionmentioning

confidence: 92%

mentioning

confidence: 99%

Predictors of Blood Pressure Control Among Hypertensives in Community Health Centers

Shelley

Tseng

Andrews

et al. 2011

American Journal of Hypertension

View full text Add to dashboard Cite

show abstract

“…Second, provider-specific differences in care for diabetic patients have been observed including increased measures of treatment inertia and decreased intensity of management for African American diabetic patients. [28][29][30] Third, a significant proportion of the observed differences have been attributed to patient-specific characteristics including socioeconomic status. 28 Recent research has also implicated racial/ethnic differences in medical mistrust and deficiencies in shared decision making as barriers to effective therapeutic relationships between minority patients and their healthcare providers.…”

Section: Discussionmentioning

confidence: 94%

Racial and Ethnic Differences in Longitudinal Blood Pressure Control in Veterans with Type 2 Diabetes Mellitus

et al. 2011

View full text Add to dashboard Cite

show abstract

“…38 While findings continually point to delays in treatment intensification, 39-43 findings of differences in delay length by race have been inconsistent. [39][40][41][42][43] On the other hand, studies of medication adherence have consistently found black patients to be less adherent to prescribed medications. [22][23][24] Our understanding of the impact of medication adherence and treatment intensification to observed racial differences in risk factor control among patients with diabetes remains limited.…”

Section: Discussionmentioning

confidence: 99%

Medication Adherence Does Not Explain Black-White Differences in Cardiometabolic Risk Factor Control among Insured Patients with Diabetes

et al. 2015

View full text Add to dashboard Cite

BACKGROUND: Among patients with diabetes, racial differences in cardiometabolic risk factor control are common. The extent to which differences in medication adherence contribute to such disparities is not known. We examined whether medication adherence, controlling for treatment intensification, could explain differences in risk factor control between black and white patients with diabetes. METHODS: We identified three cohorts of black and white patients treated with oral medications and who had poor risk factor control at baseline (2009): those with glycated hemoglobin (HbA1c) >8 % (n=37,873), low-density lipoprotein cholesterol (LDL-C) >100 mg/dl (n=27,954), and systolic blood pressure (SBP) >130 mm Hg (n=63,641). Subjects included insured adults with diabetes who were receiving care in one of nine U.S. integrated health systems comprising the SUrveillance, PREvention, and ManagEment of Diabetes Mellitus (SUPREME-DM) consortium. Baseline and follow-up risk factor control, sociodemographic, and clinical characteristics were obtained from electronic health records. Pharmacydispensing data were used to estimate medication adherence (i.e., medication refill adherence [MRA]) and treatment intensification (i.e., dose increase or addition of new medication class) between baseline and follow-up. County-level income and educational attainment were estimated via geocoding. Logistic regression models were used to test the association between race and follow-up risk factor control. Models were specified with and without medication adherence to evaluate its role as a mediator. RESULTS: We observed poorer medication adherence among black patients than white patients (p < 0.01): 50.6 % of blacks versus 39.7 % of whites were not highly adherent (i.e., MRA <80 %) to HbA1c oral medication(s); 58.4 % of blacks and 46.7 % of whites were not highly adherent to lipid medication(s); and 33.4 % of blacks and 23.7 % of whites were not highly adherent to BP medication(s). Across all cardiometabolic risk factors, blacks were significantly less likely to achieve control (p<0.01): 41.5 % of blacks and 45.8 % of whites achieved HbA1c <8 %; 52.6 % of blacks and 60.8 % of whites achieved LDL-C <100; and 45.7 % of blacks and 53.6 % of whites achieved SBP <130. Adjusting for medication adherence/treatment intensification did not alter these patterns or model fit statistics. CONCLUSIONS: Medication adherence failed to explain observed racial differences in the achievement of HbA1c, LDL-C, and SBP control among insured patients with diabetes.

show abstract

Determinants of racial/ethnic differences in blood pressure management among hypertensive patients

Cited by 27 publications

References 24 publications

Predictors of Blood Pressure Control Among Hypertensives in Community Health Centers

Predictors of Blood Pressure Control Among Hypertensives in Community Health Centers

Racial and Ethnic Differences in Longitudinal Blood Pressure Control in Veterans with Type 2 Diabetes Mellitus

Medication Adherence Does Not Explain Black-White Differences in Cardiometabolic Risk Factor Control among Insured Patients with Diabetes

Contact Info

Product

Resources

About