Journal of General Internal Medicine

, Volume 23, Issue 1, pp 81–86

Hypertension Management in Minority Communities: A Clinician Survey

  • Cheryl E. Goldstein
  • Paul L. Hebert
  • Jane E. Sisk
  • Mary Ann McLaughlin
  • Carol R. Horowitz
  • Thomas G. McGinn
Original Article



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


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.


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.


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.


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.


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.


hypertension clinician survey quality of care disparities 


  1. 1.
    Hajjar I, Kotchen TA. Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988–2000. JAMA. 2003;290:199–206.PubMedCrossRefGoogle Scholar
  2. 2.
    Burt VL, Whelton P, Roccella EJ, et al. Prevalence of hypertension in the US adult population. Results from the Third National Health and Nutrition Examination Survey 1988–1991. Hypertension. 1995;25:305–13.PubMedGoogle Scholar
  3. 3.
    Chobian AV, Bakris GL, Black HR, et al. Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII). JAMA. 2003;289:2560–72.CrossRefGoogle Scholar
  4. 4.
    JNC 6. National High Blood Pressure Education Program. The sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med. 1997;157:2413–46.Google Scholar
  5. 5.
    Klag MJ, Whelton PK, Randall BL, Neaton JD, Brancati FL, Stamler J. End-stage renal disease in African-American and white men. 16-year MRFIT findings. JAMA. 1997;277:1293–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Stockwell DH, Madhavan S, Cohen H, Gibson G, Alderman MH. The determinants of hypertension awareness, treatment, and control in an insured population. Am J Public Health. 1994;84:1768–74.PubMedCrossRefGoogle Scholar
  7. 7.
    Ahluwalia JS, McNagny SE, Rask KJ. Correlates of controlled hypertension in indigent, inner-city hypertensive patients. J Gen Intern Med. 1997;12:7–14.PubMedCrossRefGoogle Scholar
  8. 8.
    Hyman DJ, Pavlik VN. Self-reported hypertension treatment practices among primary care physicians: blood pressure thresholds, drug choices, and the role of guidelines and evidence-based medicine. Arch Intern Med. 2000;160:2281–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Hyman DJ, Pavlik VN, Vallbona C. Physician role in lack of awareness and control of hypertension. J Clin Hypertens. 2000;2:324–30.Google Scholar
  10. 10.
    Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. The fifth report of the Joint National Committee on detection, evaluation, and treatment of high blood pressure (JNC V). Arch Intern Med. 1993;153:154–83.CrossRefGoogle Scholar
  11. 11.
    Berlowitz DR, Ash AS, Hickey EC, et al. Inadequate management of blood pressure in a hypertensive population. N Engl J Med. 1998;339:1957–63.PubMedCrossRefGoogle Scholar
  12. 12.
    Oliveria SA, Lapuerta P, McCarthy BD, L’Italien GJ, Berlowitz DR, Asch SM. Physician-related barriers to the effective management of uncontrolled hypertension. Arch Intern Med. 2002;162:413–20.PubMedCrossRefGoogle Scholar
  13. 13.
    Van Ryn M. Research on the provider contribution to race/ethnicity disparities in medical care. Med Care. 2002;40(Suppl 1):I-140–51.CrossRefGoogle Scholar
  14. 14.
    Schulman KA, Berlin JA, Harless W, et al. The effect of race and sex on physicians’ recommendations for cardiac catheterization. N Engl J Med. 1999;340:618–26.PubMedCrossRefGoogle Scholar
  15. 15.
    Schwartz LM, Woloshin S, Welch HG. Misunderstandings about the effects of race and sex on physicians’ referrals for cardiac catheterization. N Engl J Med. 1999;341:279–83.PubMedCrossRefGoogle Scholar
  16. 16.
    Van Ryn M, Burke J. The effect of patient race and socio-economic status on physicians’ perceptions of patients. Soc Sci Med. 2000;50:813–28.PubMedCrossRefGoogle Scholar
  17. 17.
    Green BB, Kaplan RC, Psaty BM. How do minor changes in the definition of blood pressure control affect the reported success of hypertension treatment? Am J Manag Care. 2003;9:219–24.PubMedGoogle Scholar
  18. 18.
    The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker or diuretic. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA. 2002;288:2981–97.CrossRefGoogle Scholar
  19. 19.
    Swanson DB, Barrow HS, Friedman CP. Issues in assessment of clinical competence. Prof Educ Res. 1982;4:2.Google Scholar
  20. 20.
    Moskowitz AJ, Kuipers B, Kassirer JP. Dealing with uncetainty, risks, and trade offs in clinical decisions: a cognitive science approach. Ann Intern Med. 1988;108:435–49.PubMedGoogle Scholar
  21. 21.
    Jones TV, Gerrity MS, Earp J. Written case simulations: do they predict physicians’ behavior? J Clin Epidemiol. 1990;43:805–15.PubMedCrossRefGoogle Scholar
  22. 22.
    Kirwan JR, Chaput de Saintonge DM, Joyce CRB, Currey HLF. Clinical judgement in rheumatoid arthritis. I. Rheumatologists’ opinions and the development of “paper patients.” Ann Rheum Dis. 1983;42:644–7.PubMedCrossRefGoogle Scholar
  23. 23.
    Kirwan JR, Bellamy N, Condon H, Buchanan WW, Barnes CG. Judging “current disease activity” in rheumatoid arthritis—an international comparison. J Rheumatol 1983;10:901–5.PubMedGoogle Scholar
  24. 24.
    U.S. Centers for Disease Control and Prevention. National diabetes fact sheet., accessed September 2, 2005.

Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • Cheryl E. Goldstein
    • 1
  • Paul L. Hebert
    • 2
  • Jane E. Sisk
    • 2
  • Mary Ann McLaughlin
    • 2
  • Carol R. Horowitz
    • 2
  • Thomas G. McGinn
    • 3
  1. 1.Division of General Internal Medicine, 2E3.37 Walter C. Mackenzie Health Sciences Centre, Department of MedicineUniversity of AlbertaEdmontonCanada
  2. 2.Department of Health PolicyMount Sinai School of MedicineNew YorkUSA
  3. 3.Division of General MedicineMount Sinai School of MedicineNew YorkUSA

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