Ethnic Differences in Blood Pressure Control Among Men at Veterans Affairs Clinics and Other Health Care Sites

Rehman, Shakaib U.; Hutchinson, Frank; Hendrix, Katharine H.; Egan, Brent M.

doi:10.1016/j.accreview.2005.08.029

Cited by 11 publications

(17 citation statements)

References 25 publications

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“…[6][7][8] Many factors such as socioeconomic status, medication regimens, and cardiovascular comorbidities have been postulated as playing a role in this racial disparity in hypertension control. [3][4][5][6]9,10 Additionally, a consensus statement by the Hypertension in African Americans Working Group of the International Society on Hypertension in Blacks (ISHIB) cited poor management by health-care providers as a "key obstacle" to hypertension control in black patients. 7 Indeed, at least one study found training deficiencies in physicians who treat black patients.…”

mentioning

confidence: 99%

Racial Disparities in Hypertension Control, but Not Treatment Intensification

Umscheid

Gross

Weiner

et al. 2010

American Journal of Hypertension

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mentioning

confidence: 99%

Racial Disparities in Hypertension Control, but Not Treatment Intensification

Umscheid

Gross

Weiner

et al. 2010

American Journal of Hypertension

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“…19,20 Rehman and colleagues studied BP control between African Americans or whites in Veteran's Affair (VA) or non-VA settings. 6 BP control was comparable in white men in VA (55.6%) and non-VA settings (54.2%, P=.12). However, BP control was higher in African Americans in VA (49.4%) compared with non-VA care settings (44.0%, P<.01).…”

Section: Discussionmentioning

confidence: 87%

“…However, when the BP was properly measured by the study coordinators, 402 (38%) had controlled BP and were excluded from the trial. Another 8 were excluded because their BP was too high and 18 were excluded for other reasons (eg, failed the mental status examination, 10 untreated sleep apnea, 4 arm too large for BP cuff, 2 recent myocardial infarction, angina, stroke, heart failure, renal failure or elevated liver tests, 6 not seeing a physician in the study office, 1 declined mental status examination, 1 or withdrew consent. 1 (Note that some patients had more than one reason for exclusion.)…”

Section: Discussionmentioning

confidence: 99%

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Similar Blood Pressure Values Across Racial and Economic Groups: Baseline Data from a Group Randomized Clinical Trial

Carter

Coffey

Uribe

et al. 2013

J of Clinical Hypertension

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This paper examines baseline characteristics from a prospective, cluster-randomized trial in 32 primary care offices. Offices were first stratified by percent minorities and level of clinical pharmacy services and then randomized into one of three study groups. The only differences between randomized arms were for marital status (p=0.03) and type of insurance coverage (p<0.001). BPs were similar in Caucasians and minority subjects, primarily Blacks, who were hypertensive at baseline. On multivariate analyses, subjects who were ≥ 65 years of age had higher systolic BP (SBP) (152.4 ± 14.3 mm Hg), but lower diastolic BP (DBP) (77.3 ± 11.8 mm Hg) compared to those <65 years of age (147.4 ± 15.0/88.6 ± 10.6 mm Hg, p<0.001 for both SBP and DBP). Other factors significantly associated with higher SBP were a longer duration of hypertension (p=0.04) and lower basal metabolic index (BMI) (p=0.011). Subjects with diabetes or chronic kidney disease (CKD) had a lower SBP than those without these conditions (p<0.0001). BP was similar across racial and socioeconomic groups for subjects with uncontrolled hypertension in primary care suggesting that subjects with uncontrolled hypertension and an established primary care relationship likely have different reasons for poor BP control than other patient populations.

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“…1 Overall, 1 in 3 American adults have high blood pressure (BP), while 2 in 5 African American adults have high BP. 2 African Americans bear a greater burden of disease, 3,4 have a variable response to conventional antihypertensive medications, 5,6 and develop more severe end-organ damage. 7,8 In addition to pharmacologic therapy and lifestyle modifications, community-based interventions focusing on African Americans may improve outcomes.…”

mentioning

confidence: 99%

Antihypertensive Therapy in African Americans: Findings From an Inner‐City Ambulatory Clinic

Odigie-Okon

Zarich²,

Okon³

et al. 2010

J of Clinical Hypertension

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African Americans bear a greater burden of hypertension. Understanding prevailing epidemiologic patterns can facilitate the implementation and successful outcome of community programs. The authors assessed practice patterns of antihypertensive drug utilization and blood pressure (BP) control in a predominantly African American population in Brooklyn, NY, from January 1 to January 31, 2008. A total of 416 (53.1%) had hypertension, with a mean age of 61 years, and 267 (64%) were women. In general, 212 (50.9%) were at goal BP and 59.9% of those at goal were taking at least 2 drugs. Patient age correlated with the number of drugs used (r=0.14; P=.004). Patients taking b-blockers and calcium channel blockers were older: 63.6 vs 60.1 years (P=.01) and 62.7 vs 60.3 years (P=.07), respectively. The pattern of antihypertensive use was as follows:angiotensin-converting enzyme inhibitors, 194 (46.6%); calcium channel blockers, 162 (38.9%); diuretics, 162 (38.9%); b-blockers, 133(32%); and angiotensin receptor blockers, 93 (22.4%). The findings of age associated with the class of medications used and a predominance of angiotensin-converting enzyme inhibitors usage highlight possible gaps in appropriateness of antihypertensive therapy. The application of age-appropriate race-based antihypertensive therapy might improve BP control rates. These results strengthen arguments for investing in community-based programs to overcome possible provider-related and local health system barriers to achieving BP control goals.

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Ethnic Differences in Blood Pressure Control Among Men at Veterans Affairs Clinics and Other Health Care Sites

Cited by 11 publications

References 25 publications

Racial Disparities in Hypertension Control, but Not Treatment Intensification

Racial Disparities in Hypertension Control, but Not Treatment Intensification

Similar Blood Pressure Values Across Racial and Economic Groups: Baseline Data from a Group Randomized Clinical Trial

Antihypertensive Therapy in African Americans: Findings From an Inner‐City Ambulatory Clinic

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