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Erschienen in:
01.08.2010 | Original Research
Understanding Racial Disparities in Treatment Intensification for Hypertension Management
Erschienen in: Journal of General Internal Medicine | Ausgabe 8/2010
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Background
Disparities in blood pressure (BP) control may be a function of disparities in treatment intensification (TI).
Objective
To examine racial differences in TI, understand modifiable factors that may mediate this relationship, and explore the relative effects of TI and race on blood pressure.
Design
Prospective cohort study.
Participants
Participants were 819 black and white patients with hypertension from an urban, safety-net hospital
Main Measures
We sequentially explored the effects of patient race, sociodemographic and clinical characteristics, beliefs about BP/medications, perceptions of provider/discrimination, sodium intake, medication adherence, and provider counseling on TI, performing a series of random effects analyses. To assess the effects of race and TI on BP, we performed linear regressions, using systolic BP (SBP) as the outcome.
Key Results
Unadjusted analyses and those including sociodemographic and clinical characteristics revealed that black patients had less TI than whites (−0.31 vs.−0.24, p < 0.001), but adjustment for patient beliefs and experiences eliminated the effects of race (β =−0.02, p = 0.5). Increased patient concerns about BP medications were related to lower TI, as was more provider counseling (β =−0.06, p = 0.02 and β = −0.01, p = 0.001, respectively). In the unadjusted analysis, black race was a significant predictor of SBP (134 mm/Hg for blacks vs. 131 mm/Hg for whites, p = 0.009), but when both race and TI were included in the model, TI was a significant predictor of SBP (final SBP 2.0 mm/Hg lower for each additional therapy increase per 10 visits, p < 0.001), while race was not (Blacks 1.6 mm/Hg higher than whites, p = 0.17).
Conclusions
Improved patient–provider communication targeted towards addressing patient concerns about medications may have the potential to reduce racial disparities in TI and ultimately, BP control.