Document Detail


Understanding racial disparities in treatment intensification for hypertension management.
MedLine Citation:
PMID:  20386998     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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 (beta =-0.02, p = 0.5). Increased patient concerns about BP medications were related to lower TI, as was more provider counseling (beta =-0.06, p = 0.02 and beta = -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.
Authors:
Meredith Manze; Adam J Rose; Michelle B Orner; Dan R Berlowitz; Nancy R Kressin
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, Non-P.H.S.     Date:  2010-04-13
Journal Detail:
Title:  Journal of general internal medicine     Volume:  25     ISSN:  1525-1497     ISO Abbreviation:  J Gen Intern Med     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-07-05     Completed Date:  2011-04-28     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  8605834     Medline TA:  J Gen Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  819-25     Citation Subset:  IM    
Affiliation:
Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA. meredith.manze@bmc.org
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MeSH Terms
Descriptor/Qualifier:
African Americans / statistics & numerical data*
Antihypertensive Agents / therapeutic use*
Blood Pressure
European Continental Ancestry Group / statistics & numerical data*
Female
Health Knowledge, Attitudes, Practice
Healthcare Disparities*
Humans
Hypertension / drug therapy*
Linear Models
Male
Medication Adherence
Middle Aged
Multivariate Analysis
Prospective Studies
Questionnaires
Statistics as Topic
Grant Support
ID/Acronym/Agency:
R01 HL072814/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Antihypertensive Agents
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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