Original Article

Journal of General Internal Medicine

, Volume 23, Issue 1, pp 81-86

Hypertension Management in Minority Communities: A Clinician Survey

  • Cheryl E. GoldsteinAffiliated withDivision of General Internal Medicine, 2E3.37 Walter C. Mackenzie Health Sciences Centre, Department of Medicine, University of Alberta Email author 
  • , Paul L. HebertAffiliated withDepartment of Health Policy, Mount Sinai School of Medicine
  • , Jane E. SiskAffiliated withDepartment of Health Policy, Mount Sinai School of Medicine
  • , Mary Ann McLaughlinAffiliated withDepartment of Health Policy, Mount Sinai School of Medicine
  • , Carol R. HorowitzAffiliated withDepartment of Health Policy, Mount Sinai School of Medicine
  • , Thomas G. McGinnAffiliated withDivision of General Medicine, Mount Sinai School of Medicine

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Abstract

BACKGROUND

Rates of blood pressure (BP) control are lower in minority populations compared to whites.

OBJECTIVE

As part of a project to decrease health-related disparities among ethnic groups, we sought to evaluate the knowledge, attitudes, and management practices of clinicians caring for hypertensive patients in a predominantly minority community.

DESIGN/PARTICIPANTS

We developed clinical vignettes of hypertensive patients that varied by comorbidity (type II diabetes mellitus, chronic renal insufficiency, coronary artery disease, or isolated systolic hypertension alone). We randomly assigned patient characteristics, e.g., gender, age, race/ethnicity, to each vignette. We surveyed clinicians in ambulatory clinics of the 4 hospitals in East/Central Harlem, NY.

MEASUREMENTS

The analysis used national guidelines to assess the appropriateness of clinicians’ stated target BP levels. We also assessed clinicians’ attitudes about the likelihood of each patient to achieve adequate BP control, adhere to medications, and return for follow-up.

RESULTS

Clinicians’ target BPs were within 2 mm Hg of the recommendations 9% of the time for renal disease patients, 86% for diabetes, 94% for isolated systolic hypertension, and 99% for coronary disease. BP targets did not vary by patient or clinician characteristics. Clinicians rated African-American patients 8.4% (p = .004) less likely and non-English speaking Hispanic patients 8.1% (p = .051) less likely than white patients to achieve/maintain BP control.

CONCLUSIONS

Clinicians demonstrated adequate knowledge of recommended BP targets, except for patients with renal disease. Clinicians did not vary management by patients’ sociodemographics but thought African-American, non-English-speaking Hispanic and unemployed patients were less likely to achieve BP control than their white counterparts.

KEY WORDS

hypertension clinician survey quality of care disparities