More than 20% of racial disparities in hypertension related to treatment intensification
At least one-fifth of racial disparities in hypertension treatment may stem from racial inequities in treatment intensification, according to a study presented at the virtual American Heart Association Scientific Sessions.
“Missed opportunities for increasing therapy may be one of the most significant contributors to racial disparities in blood pressure outcomes that may, in turn, contribute to poor health for Black Americans,” Valy Fontil, MD, MAS, assistant professor of medicine at the University of California, San Francisco, said in a press release.
Researchers assessed the likelihood of BP control (BP < 140/90 mm Hg) in 6,556 patients (mean age, 57 years; 41% women; 44% Black) with a diagnosis of hypertension and at least one clinic visit with uncontrolled BP in 12 San Francisco clinics from 2015 to 2017. Researchers used the standard-based method to calculate treatment intensification of a dose increase or medication addition and measured missed clinic visits as the number of “no-shows” in the 4 weeks after uncontrolled BP.
Black patients had more missed opportunities for treatment intensification (beta = 0.03; P < .001) and more missed visits (beta = 0.35; P < .001) compared with other groups. After accounting for such differences, researchers observed a lower likelihood of achieving BP control among Black patients compared with white patients, as OR improved from 0.8 (95% CI, 0.72-0.90) to 0.87 (95% CI, 0.77-0.98), suggesting that more equitable care could reduce racial disparities in BP control by at least 35%, according to the Fontil.
The indirect effect of decreased treatment intensification accounted for 22% of the total effect of Black race on BP control and the indirect effect of missed visits accounted for 13%.
“Our findings should prompt further investigation to determine why Black patients are less likely to have blood pressure therapy increased and why Asian Americans are more likely to receive more aggressive treatment,” Fontil said in the release. “These findings also reemphasize the call for adopting treatment protocols and clinical decision supports that can help standardize quality of care for hypertension and perhaps other chronic diseases.”
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Fontil V, et al. Abstract MP269. Presented at: American Heart Association Scientific Sessions; Nov. 13-17, 2020 (virtual meeting).
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