Journal of General Internal Medicine

, Volume 25, Issue 8, pp 819–825

Understanding Racial Disparities in Treatment Intensification for Hypertension Management

  • Meredith Manze
  • Adam J. Rose
  • Michelle B. Orner
  • Dan R. Berlowitz
  • Nancy R. Kressin
Original Research

DOI: 10.1007/s11606-010-1342-9

Cite this article as:
Manze, M., Rose, A.J., Orner, M.B. et al. J GEN INTERN MED (2010) 25: 819. doi:10.1007/s11606-010-1342-9

Abstract

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 (β =−0.02, p = 0.5). Increased patient concerns about BP medications were related to lower TI, as was more provider counseling (β =−0.06, p = 0.02 and β = −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.

KEY WORDS

disparitiestreatment intensificationhypertension

Copyright information

© Society of General Internal Medicine 2010

Authors and Affiliations

  • Meredith Manze
    • 1
    • 2
  • Adam J. Rose
    • 3
    • 1
  • Michelle B. Orner
    • 3
  • Dan R. Berlowitz
    • 3
    • 2
  • Nancy R. Kressin
    • 4
    • 3
    • 1
  1. 1.Section of General Internal MedicineBoston University School of MedicineBostonUSA
  2. 2.Health Policy & Management DepartmentBoston University School of Public HealthBostonUSA
  3. 3.Center for Health Quality, Outcomes, and Economic ResearchBedford VA Medical CenterBedfordUSA
  4. 4.VA Boston Healthcare SystemBostonUSA