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.
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Acknowledgements
This work was presented in abstract form at The Society of General Internal Medicine 26th Annual Meeting, April 30 to May 3, 2003, in Vancouver, British Columbia, and at the Academy Health Annual Research Meeting, June 27–29, 2003, in Nashville, TN.
Funding Source
Agency for Healthcare Research and Quality, P01 HS10859; National Center for Minority Health and Health Disparities, National Institutes of Health, P60 MD00270-01; and The Commonwealth Fund, 20030088.
Conflict of Interest
None disclosed.
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This research project has not been published in any other peer-reviewed media and is not under review elsewhere. This study was conducted at the Mount Sinai School of Medicine, New York. All of the authors listed on the manuscript have contributed sufficiently to the project to be included as authors.
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Goldstein, C.E., Hebert, P.L., Sisk, J.E. et al. Hypertension Management in Minority Communities: A Clinician Survey. J GEN INTERN MED 23, 81–86 (2008). https://doi.org/10.1007/s11606-007-0413-z
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DOI: https://doi.org/10.1007/s11606-007-0413-z