National Trends in Racial and Ethnic Disparities in Antihypertensive Medication Use and Blood Pressure Control Among Adults With Hypertension, 2011–2018

Lu, Yuan; Liu, Yuntian; Dhingra, Lovedeep Singh; Caraballo, César; Mahajan, Shiwani; Spatz, Erica S.; Onuma, Oyere; Herrin, Jeph; Krumholz, Harlan M.

doi:10.1161/hypertensionaha.121.18381

Cited by 15 publications

(9 citation statements)

References 33 publications

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“…A higher proportion of Black than White patients were treated with 3 or more antihypertensive medications; however, the prevalence of uncontrolled BP was higher in Black than in White patients throughout the study period, with the lowest BP control among Black individuals aged 18 to 49 years. In an NHANES analysis from 2011-2018, Lu and colleagues found that Black adults had a similar treatment rate, received more intensive antihypertensive therapy if treated, and had lower BP control compared with White adults. Lower medication adherence, environmental issues, and lifestyle factors may be contributors to more intensive treatment yet lower BP control among Black patients …”

Section: Discussionmentioning

confidence: 99%

“…Factors Associated With Uncontrolled Blood Pressure Among Kaiser Permanente Southern California Adults With Hypertension, Overall and Treated With Antihypertensive Medication, 2019Blood Pressure Control Among Black and White Adults Following a Quality Improvement Program treated with 3 or more antihypertensive medications; however, the prevalence of uncontrolled BP was higher in Black than in White patients throughout the study period, with the lowest BP control among Black individuals aged 18 to 49 years. In an NHANES analysis from 2011-2018, Lu and colleagues17 found that Black adults had a similar treatment rate, received more intensive antihypertensive therapy if treated, and had lower BP control compared with White adults. Lower medication adherence, environmental issues, and lifestyle factors may be contributors to more…”

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Blood Pressure Control Among Black and White Adults Following a Quality Improvement Program in a Large Integrated Health System

et al. 2023

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ImportanceA higher percentage of non-Hispanic Black (hereinafter, Black) adults vs non-Hispanic White (hereinafter, White) adults with hypertension have uncontrolled blood pressure (BP) contributing to racial and ethnic disparities in cardiovascular disease. In 2010, Kaiser Permanente Southern California began implementing quality improvement (QI) strategies aimed at reducing this disparity.ObjectiveTo examine the change in BP control between Black and White patients before and after the implementation of a QI program.Design, Setting, and ParticipantsA QI quasi-experimental, difference-in-difference analysis was conducted of Kaiser Permanente Southern California patients 18 years or older included in the population care management hypertension registry. The study was conducted from December 31, 2008, to December 31, 2019. Data analysis was performed from November 20, 2020, to November 7, 2022.InterventionsQuality improvement program implementation began in 2010.Main Outcomes and MeasuresBlood pressure control (systolic BP &lt;140 mm Hg and diastolic BP &lt;90 mm Hg) was assessed using the last outpatient BP measurement in each calendar year. Changes in BP control between Black and White patients from before (2008-2009) to after (2016-2019) implementation of the QI program were examined using a difference-in-difference analysis. Blood pressure control disparities from 2008 through 2019 by age, sex, race and ethnicity, and factors associated with BP control were examined.ResultsThe number of patients with hypertension increased from 624 094 in 2008 (mean [SD] age, 61.8 [13.5] years; 330 551 [53.0%] female patients; 89 407 [14.3%] Black and 284 116 [45.5%] White patients) to 855 257 in 2019 (mean [SD] age, 64.5 [13.6] years; 444 422 [52.0%] female patients; 107 054 [12.5%] Black and 331 932 [38.8%] White patients). Blood pressure control increased an absolute 4.6% (95% CI, 4.3%-4.8%) among Black patients and 2.1% (95% CI, 2.0%-2.2%) among White patients from before to after the QI program implementation (difference-in-difference: 2.5%; 95% CI, 2.2%-2.8%). The largest reduction in BP control disparity between Black and White female patients was for those aged 50 to 64 years (difference-in-difference: 3.8%; 95% CI, 3.2%-4.4%) and for those aged 18 to 49 years between Black and White male patients (difference-in-difference: 4.2%; 95% CI, 3.0%-5.5%). The proportion of BP control among Black male patients aged 18 to 49 years was the lowest throughout 2008-2019 compared with male and female patients in other age and racial and ethnic groups. In 2019, uncontrolled BP was more common among Black vs White patients (prevalence ratio: 1.13; 95% CI, 1.12-1.14).Conclusions and RelevanceThis QI program noted that disparities in BP control between Black and White patients were decreased but not eliminated following implementation of QI strategies aimed at reducing disparities in BP control. These findings suggest that more focused interventions may be needed to increase BP control among Black individuals.

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Section: Discussionmentioning

confidence: 99%

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Blood Pressure Control Among Black and White Adults Following a Quality Improvement Program in a Large Integrated Health System

et al. 2023

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“…One study showed differences in hypertension control rates, awareness rates, and antihypertensive medication use by sex, race, and age. 41 According to the National Center for Health Statistics, the prevalence of hypertension in US adults has been on the rise for the past 20 years in men, but women have shown a decreasing trend. 2 In also, among US adults, there were differences in CKD prevalence trends by economic and social status.…”

Section: Original Articlementioning

confidence: 99%

Prevalence of Chronic Kidney Disease Among US Adults With Hypertension, 1999 to 2018

Zeng

Liu

et al. 2023

Hypertension

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BACKGROUND: Hypertension is a major cause of end-stage renal disease. Assessing temporal trends in the prevalence of chronic kidney disease (CKD) in hypertension could provide information for public health policies and plans. METHODS: From the National Health and Nutrition Examination Survey from 1999 to 2018, a probability sample of adults aged ≥20 years was collected. The primary outcomes were classified according to the estimated glomerular filtration rate and urinary albumin. Trend tests were performed to assess age-standardized prevalence trends of CKD, albuminuria, and macroalbuminuria in US adults with hypertension. RESULTS: A total of 23 120 US adults with hypertension were included in this study. The prevalence of any CKD, albuminuria, or macroalbuminuria in hypertension remained relatively stable. However, the age-standardized prevalence of stage 1 CKD in hypertension increased from 4.9% in 2003 to 2006 to 7.0% in 2015 to 2018 ( P= 0.0077 for trend). The age-standardized prevalence of stage 3b CKD in hypertension decreased from 2.9% in 2011 to 2014 to 2.1% in 2015 to 2018 ( P= 0.0350 for trend). A similar trend was observed for the age-standardized prevalence of stages 3 to 5 CKD in hypertension, which declined from 10.9% in 2011 to 2014 to 8.9% in 2015 to 2018 ( P= 0.0160 for trend). CONCLUSIONS: Among US adults with hypertension, the prevalence of any CKD, albuminuria, and macroalbuminuria remained relatively stable from 1999 to 2018, whereas the hypertensive population showed an increasing trend in stage 1 CKD from 2003 to 2006 to 2015 to 2018 and a decreasing trend in the prevalence of stages 3 to 5 and 3b CKD from 2011 to 2014 to 2015 to 2018.

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“…1 This percentage further dropped to 19% using the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guideline BP control definition (BP <130/80 mmHg). 1, 2 Thus, hypertension remains a leading cause of preventable deaths in the country. 3, 4…”

Section: Introductionmentioning

confidence: 99%

Use of electronic health records to develop an actionable taxonomy of persistent hypertension

Khidir

et al. 2022

Preprint

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Background: The digital transformation of medical data presents opportunities for novel approaches to manage patients with persistent hypertension (defined as multiple measurements of elevated BP over 6 months). We sought to develop an actionable taxonomy of patients with persistent hypertension based on clinical data from the electronic health records (EHR). Methods: This qualitative study was a content analysis of clinician notes in the EHR of patients in the Yale New Haven Health System. Eligible patients were 18 to 85 years and had blood pressure ≥160/100 mmHg at five or more consecutive outpatient visits between January 1st 2013 to October 31st 2018. A total of 4,828 patients met criteria, of which 200 records were randomly selected for chart review. Through a systematic, inductive approach, we developed a rubric to abstract data from the EHR and then analyzed the abstracted data qualitatively using conventional content analysis until saturation was reached. Results: We reached saturation with 115 patients, who had a mean age of 68.1 (SD, 11.6) years; 54.8% were female; 52.2%, 30.4%, and 13.9% were White, Black, and Hispanic people. We identified three content domains related to persistence of hypertension: (1) non-intensification of pharmacological treatment (defined as absence of antihypertensive treatment intensification in response to persistent severely elevated blood pressure) with four subcategories, including provider purview, competing medical priorities, patient preference, and de-emphasis of the office measurement; (2) non-implementation of prescribed treatment (defined as a documentation of provider recommending a specified treatment plan to address hypertension but treatment plan not being implemented) with four subcategories, including obstacles to obtaining medications, psychosocial barriers, patient misunderstanding, and negative medication experience; and (3) non-response to prescribed treatment (defined as clinician-acknowledged persistent hypertension despite documented effort to escalate existing pharmacologic agents and addition of additional pharmacologic agents with presumption of adherence) with two subcategories, including resistant hypertension and secondary hypertension. Conclusions: This study presents a novel actionable taxonomy for classifying patients with persistent hypertension by their contributing causes based on EHR data. These categories can be automated and linked to specific types of actions to address them.

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National Trends in Racial and Ethnic Disparities in Antihypertensive Medication Use and Blood Pressure Control Among Adults With Hypertension, 2011–2018

Cited by 15 publications

References 33 publications

Blood Pressure Control Among Black and White Adults Following a Quality Improvement Program in a Large Integrated Health System

Blood Pressure Control Among Black and White Adults Following a Quality Improvement Program in a Large Integrated Health System

Prevalence of Chronic Kidney Disease Among US Adults With Hypertension, 1999 to 2018

Use of electronic health records to develop an actionable taxonomy of persistent hypertension

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