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March 27, 2023
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Q&A: Hypertension care for underrepresented populations should focus on self-management

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Key takeaways:

  • Hypertension care in the United States is suboptimal, particularly for underrepresented groups.
  • Patients said that more focus should be on lifestyle modifications rather than medications.

Providers should tailor approaches to hypertension care, including self-care and treatment intensification, to improve hypertension management for patients from underrepresented racial and ethnic populations, according to researchers.

Julie C. Lauffenburger, PharmD, PhD, an assistant professor at Harvard Medical School and Brigham and Women’s Hospital, and colleagues conducted a qualitative study from Oct. 1, 2020, to March 31, 2021, to assess clinician and patient perspectives on facilitators and barriers to hypertension control in a health care system that is racially and ethnically diverse.

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The participants reported having heterogeneous experiences with hypertension care, even in the same clinic, and said that more focus should be on lifestyle modifications rather than medications, especially for people from underrepresented racial and ethnic populations.

The researchers identified several themes that they wrote are relevant to managing hypertension for people from underrepresented racial and ethnic populations, including hesitancy in intensifying medications by both patients and clinicians, variation in BP self-monitoring recommendations and uptake, difficulty with self-management activities — lifestyle modifications in particular — and more.

To improve hypertension management among these populations in primary care, the researchers wrote that “more intentional ways of supporting treatment intensification, self-care, and follow-up care are needed.”

Lauffenburger spoke with Healio about what the study revealed, disparities in hypertension care, the role of lifestyle modifications and more.

Healio: Can you describe your findings and their importance?

Lauffenburger: We found that patients with hypertension and their primary care providers within a diverse population feel that they most need help with lifestyle modifications, blood pressure self-monitoring, and supporting treatment intensification. Beginning patients on medication is less of an issue than supporting these other types of actions. Patients and providers alike also do not believe that adherence to medication is a much of a problem in their population. The ability for health IT tools to fill these gaps is also modest, as electronic health records, for example, do not support some actions that would be helpful.

Healio: What were some of the disparities that you found?

Lauffenburger: Lifestyle modifications seem even more challenging for low-income individuals, citing that there is a lot of patient confusion around what patients can manage with their busy lifestyles. Access to self-monitoring tools may also be more difficult in this population.

Healio: You wrote that participants felt that more focus should be placed on lifestyle modifications for hypertension than medications, particularly for those from underrepresented racial and ethnic populations.

Lauffenburger: Typically, we mean a low-salt diet (eg, DASH diet) and getting plenty of healthy fruits and vegetables and physical activity to meet guideline targets. These are typically even more difficult in this population because of the lack of healthy grocery store options, and for many, fewer safe outdoor spaces to get physical activity.

Healio: You note that “more attention may need to be paid to ways to support treatment intensification and self-management, particularly through asynchronous interventions.” Can you expand on this? What would this look like – especially the asynchronous interventions?

Lauffenburger: We mean things like blood pressure monitoring or self-titration of medications — things that don’t require an office visit in order to execute. This could be facilitated through better electronic tools (like a more accessible or robust patient portal), or perhaps a robust population health management program. This is even more important because of knowledge about the emerging variability in blood pressure readings across visits.

Healio: What is the take-home message for primary care providers?

Lauffenburger: I think the biggest take-home points are that focusing on treatment intensification and self-management seem key for this population and working towards ways of supporting patients is going to be helpful.

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