| Understanding racial disparities in treatment intensification for hypertension management. | |
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MedLine Citation:
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PMID: 20386998 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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 (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. |
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Authors:
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Meredith Manze; Adam J Rose; Michelle B Orner; Dan R Berlowitz; Nancy R Kressin |
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Publication Detail:
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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:
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Title: Journal of general internal medicine Volume: 25 ISSN: 1525-1497 ISO Abbreviation: J Gen Intern Med Publication Date: 2010 Aug |
Date Detail:
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Created Date: 2010-07-05 Completed Date: 2011-04-28 Revised Date: 2011-08-03 |
Medline Journal Info:
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Nlm Unique ID: 8605834 Medline TA: J Gen Intern Med Country: United States |
Other Details:
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Languages: eng Pagination: 819-25 Citation Subset: IM |
Affiliation:
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Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA. meredith.manze@bmc.org |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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African Americans
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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:
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R01 HL072814/HL/NHLBI NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Antihypertensive Agents |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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