Health Professionals’ Perceptions of Disparities in Hypertension Control: A Mixed Methods Study

Abstract

Background Health professionals’ commitment is needed to address disparities in hypertension control by ancestry, but their perceptions regarding these disparities are understudied. Methods Cross-sectional mixed-methods study in a universal healthcare setting in the Netherlands. Snowball sampling was used to include professionals practicing in a large multi-city conglomerate including the capital city. Online surveys were collected, and survey participants were randomly selected for in-depth interviews. We used quantitative and qualitative methods to analyze health professionals’ awareness, beliefs, and possible interventions regarding these disparities. Results We analyzed questionnaire data of 77 health professionals (medical doctors n=70, nurses=7), whereas 13 were interviewed. Most professionals were women (59%), general practitioner (81%); and White-European (77%), with 79% caring for patients of diverse ancestry. Disparities in hypertension control by ancestry were perceived to exist nationally (83% [95% CI, 75;91]), but less so in health professionals’ own clinic (62% [52;73]), or among their own patients (56% [45;67]). Survey respondents emphasized patient rather than provider-level factors as mediators of poor hypertension control by ancestry. The collection of data on patients’ ancestry, updating guidelines, and professional training were considered helpful to reduce disparities. Interviewees further emphasized patient-level factors, but also the need to better educate health professionals and increase their awareness. Conclusions This explorative study finds that health professionals predominantly attribute disparities in hypertension control to patient-level factors. Awareness of disparities was lower for more proximate healthcare settings. These data emphasize the need to consider health professionals’ perceptions when addressing disparities in hypertension control.

2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension

“…Persistent social disadvantages from individual and structural racism, including neighborhood segregation [1043][1044][1045], ethnic disparities or inequalities in access to care are increasingly recognized as driving factors for resulting differences in hypertension and increased CV morbidity and mortality [1046,1047]. Disparities in hypertension control have also been attributed to patient-level rather than provider or system-level factors, both converging to promote therapeutic inertia [1048]. Other studies on extra-European origin migrant communities reflect the USA-derived knowledge that hypertension is more prevalent in European immigrants of heterogeneous African origin than in local populations [1049].…”

“…However, 24, 28 and 41% of patients of the corresponding groups received 3 drugs, including the BB atenolol. A recent systematic review and meta-analysis [1052] indicated that, in hypertensive adults of African ancestry, BP reduction was similar across initially administered dual combination therapy containing an RAS inhibitor with a CCB, or a diuretic while with a BB in combination therapy, SBP showed a 3.8 mmHg higher SBP compared with other combinations [1048,1052]. An RCT with African patients from seven SSA countries has also shown an effective BP reduction (ABPM) using a CCB in combination with either a Thiazide or an ACEi [1055].…”