Journal of General Internal Medicine

, Volume 23, Issue 5, pp 692–698

Racial Differences in Blood Pressure Control: Potential Explanatory Factors

Authors

    • Center for Health Services Research in Primary Care Durham Veterans Affairs Medical Center (152)
    • Department of Medicine, Division of General Internal MedicineDuke University
    • Department of Psychiatry and Behavioral Sciences and Center for Aging and Human DevelopmentDuke University
  • Benjamin Powers
    • Center for Health Services Research in Primary Care Durham Veterans Affairs Medical Center (152)
    • Department of Medicine, Division of General Internal MedicineDuke University
  • Janet M. Grubber
    • Center for Health Services Research in Primary Care Durham Veterans Affairs Medical Center (152)
    • Department of Medicine, Division of General Internal MedicineDuke University
  • Carolyn T. Thorpe
    • Center for Health Services Research in Primary Care Durham Veterans Affairs Medical Center (152)
  • Maren K. Olsen
    • Center for Health Services Research in Primary Care Durham Veterans Affairs Medical Center (152)
    • Department of Biostatistics and BioinformaticsDuke University
  • Melinda Orr
    • Center for Health Services Research in Primary Care Durham Veterans Affairs Medical Center (152)
  • Eugene Z. Oddone
    • Center for Health Services Research in Primary Care Durham Veterans Affairs Medical Center (152)
    • Department of Medicine, Division of General Internal MedicineDuke University
Populations at Risk

DOI: 10.1007/s11606-008-0547-7

Cite this article as:
Bosworth, H.B., Powers, B., Grubber, J.M. et al. J GEN INTERN MED (2008) 23: 692. doi:10.1007/s11606-008-0547-7

Summary

Objective

The objective of the study was to identify potential explanatory factors for racial differences in blood pressure (BP) control.

Design

The design of the study was a cross-sectional study

Patients/Participants

The study included 608 patients with hypertension who were either African American (50%) or white (50%) and who received primary care in Durham, NC.

Measurements and Main Results

Baseline data were obtained from the Take Control of Your Blood pressure study and included clinical, demographic, and psychosocial variables potentially related to clinic BP measures. African Americans were more likely than whites to have inadequate baseline clinic BP control as defined as greater than or equal to 140/90 mmHg (49% versus 34%; unadjusted odds ratio [OR] 1.8; 95% confidence interval [CI] 1.3–2.5). Among factors that may explain this disparity, being older, reporting hypertension medication nonadherence, reporting a hypertension diagnosis for more than 5 years, reporting high levels of stress, being worried about hypertension, and reporting an increased number of medication side effects were related to inadequate BP control. In adjusted analyses, African Americans continue to have poor BP control relative to whites; the magnitude of the association was reduced (OR = 1.5; 95% CI 1.0–2.1). Medication nonadherence, worries about hypertension, and older age (>70) continued to be related to poor BP control.

Conclusions

In this sample of hypertensive patients, there were a number of factors associated with poor BP control that partially explained the observed racial disparity in hypertension control including age, medication nonadherence, and worry about BP. Medication nonadherence is of particular interest because it is a potentially modifiable factor that might be used to reduce the racial disparity in BP control.

KEY WORDS

racial disparityhypertensionadherencepsychosocial

Copyright information

© Society of General Internal Medicine 2008