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Determinants of racial/ethnic differences in blood pressure management among hypertensive patients.

Hicks LS, Shaykevich S, Bates DW, Ayanian JZ - BMC Cardiovasc Disord (2005)

Bottom Line: Blacks (81.9%) and Whites (80.3%) were more likely than Latinos (71.5%) to have therapy intensified (P = 0.03).After adjustment for racial differences in the number of outpatient visits and presence of diabetes, there were no racial differences in rates of intensification.We found that racial/ethnic differences in therapy intensification were largely accounted for by differences in frequency of clinic visits and in the prevalence of diabetes.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of General Internal Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA. hicks@hcp.med.harvard.edu

ABSTRACT

Background: Prior literature has shown that racial/ethnic minorities with hypertension may receive less aggressive treatment for their high blood pressure. However, to date there are few data available regarding the confounders of racial/ethnic disparities in the intensity of hypertension treatment.

Methods: We reviewed the medical records of 1,205 patients who had a minimum of two hypertension-related outpatient visits to 12 general internal medicine clinics during 7/1/01-6/30/02. Using logistic regression, we determined the odds of having therapy intensified by patient race/ethnicity after adjustment for clinical characteristics.

Results: Blacks (81.9%) and Whites (80.3%) were more likely than Latinos (71.5%) to have therapy intensified (P = 0.03). After adjustment for racial differences in the number of outpatient visits and presence of diabetes, there were no racial differences in rates of intensification.

Conclusion: We found that racial/ethnic differences in therapy intensification were largely accounted for by differences in frequency of clinic visits and in the prevalence of diabetes. Given the higher rates of diabetes and hypertension related mortality among Hispanics in the U.S., future interventions to reduce disparities in cardiovascular outcomes should increase physician awareness of the need to intensify drug therapy more agressively in patients without waiting for multiple clinic visits, and should remind providers to treat hypertension more aggressively among diabetic patients.

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Flow diagram of algorithm for determining an "intensified case." Inter-rater reliability was high (kappa 0.90). We identified a total of 782 cases as either an "intensified case (N = 600) or a "non-intensified case" (N = 157).
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Figure 1: Flow diagram of algorithm for determining an "intensified case." Inter-rater reliability was high (kappa 0.90). We identified a total of 782 cases as either an "intensified case (N = 600) or a "non-intensified case" (N = 157).

Mentions: Our methods for identifying intensified cases among our cohort have been previously described [13]. Because we were examining the quality of care delivered to hypertension patients prior to July of 2002, approximately one year before the release of the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC VII) [14], we used JNC VI definitions for blood pressure control in order to examine whether therapy was appropriately intensified. We classified each visit into two categories, intensified visits (an increase in intensity of drug therapy) versus non-intensified visits (a decrease or no change in intensity of drug therapy) according to previously published definitions of changes in medications [2]. We developed an algorithm to determine whether a patient received at least one increase in drug therapy (an increase in drug dose or addition of new medication) in response to a repeatedly elevated BP during the study period (Figure 1). Each patient with fewer than two visits with an elevated BP (N = 356) was excluded from the algorithm. Each patient with an uncontrolled BP at more than one visit was identified as either an intensified case (at least one drug increase) or a non-intensified case (no drug increases). Each reviewer examined a subset of 30 records; we then tested for inter-rater reliability and found excellent agreement among reviewers (kappa = 0.90).


Determinants of racial/ethnic differences in blood pressure management among hypertensive patients.

Hicks LS, Shaykevich S, Bates DW, Ayanian JZ - BMC Cardiovasc Disord (2005)

Flow diagram of algorithm for determining an "intensified case." Inter-rater reliability was high (kappa 0.90). We identified a total of 782 cases as either an "intensified case (N = 600) or a "non-intensified case" (N = 157).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC1173097&req=5

Figure 1: Flow diagram of algorithm for determining an "intensified case." Inter-rater reliability was high (kappa 0.90). We identified a total of 782 cases as either an "intensified case (N = 600) or a "non-intensified case" (N = 157).
Mentions: Our methods for identifying intensified cases among our cohort have been previously described [13]. Because we were examining the quality of care delivered to hypertension patients prior to July of 2002, approximately one year before the release of the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC VII) [14], we used JNC VI definitions for blood pressure control in order to examine whether therapy was appropriately intensified. We classified each visit into two categories, intensified visits (an increase in intensity of drug therapy) versus non-intensified visits (a decrease or no change in intensity of drug therapy) according to previously published definitions of changes in medications [2]. We developed an algorithm to determine whether a patient received at least one increase in drug therapy (an increase in drug dose or addition of new medication) in response to a repeatedly elevated BP during the study period (Figure 1). Each patient with fewer than two visits with an elevated BP (N = 356) was excluded from the algorithm. Each patient with an uncontrolled BP at more than one visit was identified as either an intensified case (at least one drug increase) or a non-intensified case (no drug increases). Each reviewer examined a subset of 30 records; we then tested for inter-rater reliability and found excellent agreement among reviewers (kappa = 0.90).

Bottom Line: Blacks (81.9%) and Whites (80.3%) were more likely than Latinos (71.5%) to have therapy intensified (P = 0.03).After adjustment for racial differences in the number of outpatient visits and presence of diabetes, there were no racial differences in rates of intensification.We found that racial/ethnic differences in therapy intensification were largely accounted for by differences in frequency of clinic visits and in the prevalence of diabetes.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of General Internal Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA. hicks@hcp.med.harvard.edu

ABSTRACT

Background: Prior literature has shown that racial/ethnic minorities with hypertension may receive less aggressive treatment for their high blood pressure. However, to date there are few data available regarding the confounders of racial/ethnic disparities in the intensity of hypertension treatment.

Methods: We reviewed the medical records of 1,205 patients who had a minimum of two hypertension-related outpatient visits to 12 general internal medicine clinics during 7/1/01-6/30/02. Using logistic regression, we determined the odds of having therapy intensified by patient race/ethnicity after adjustment for clinical characteristics.

Results: Blacks (81.9%) and Whites (80.3%) were more likely than Latinos (71.5%) to have therapy intensified (P = 0.03). After adjustment for racial differences in the number of outpatient visits and presence of diabetes, there were no racial differences in rates of intensification.

Conclusion: We found that racial/ethnic differences in therapy intensification were largely accounted for by differences in frequency of clinic visits and in the prevalence of diabetes. Given the higher rates of diabetes and hypertension related mortality among Hispanics in the U.S., future interventions to reduce disparities in cardiovascular outcomes should increase physician awareness of the need to intensify drug therapy more agressively in patients without waiting for multiple clinic visits, and should remind providers to treat hypertension more aggressively among diabetic patients.

Show MeSH
Related in: MedlinePlus