Clinical research studyAJM OnlineRacial Differences in Blood Pressure Control: Potential Explanatory Factors
Section snippets
Methods
The setting for this study was the Durham Veterans Affairs Medical Center Primary Care Clinics, which involve two sites (hospital-based general medicine clinic and women’s health clinic). There are 30 primary care providers who provide care in this continuity setting.
Patients were enrolled in an ongoing randomized controlled health services intervention trial to improve blood pressure control. The Veteran Study to Improve the Control of Hypertension is a 4-year trial that evaluates both a
Analyses
We conducted 3 sets of logistic regression analyses to assess possible mediating factors in the relationship between race and blood pressure control. The first set of analyses examined the direct association between race and blood pressure control (pathway a) (Figure). Second, the relationship between race and potential mediators of poor blood pressure control were examined using bivariable analyses (pathway b). Last, we examined the relationship between mediators and blood pressure control
Patient Sample
Patients’ mean age was 63 years, 98% were male, 41% were African American, and 59% were white. The proportion of African Americans enrolled in the current study represent the proportion seen in the Durham Veterans Affairs Medical Center. A majority of the sample (68%) were married, and 22% lived alone. Half of the sample (51%) had a high school education or less, 21% reported having inadequate incomes, and 29% were employed. In terms of clinical information, 69% of the sample reported taking
Discussion
In this sample of veterans with hypertension and minimal financial barriers to medical care, there were strong racial differences in blood pressure control. This racial difference was not fully explained by more than 20 potential mediating factors. Our findings confirm previous reports of racial differences in blood pressure control. The findings also suggest that although poor medication adherence is an important component of poor blood pressure control, racial differences in blood pressure
References (60)
- et al.
A retrospective, population-based analysis of persistence with antihypertensive drug therapy in primary care practice in Italy
Clin Ther
(2002) Improving compliance and increasing control of hypertension needs of special hypertensive populations
Am Heart J
(1991)- et al.
Nurse administered telephone intervention for blood pressure controla patient-tailored multifactorial intervention
Patient Educ Couns
(2005) - et al.
Development of a brief test to measure functional health literacy
Patient Educ Couns
(1999) - et al.
Racial/ethnic differences in hypertension and hypertension treatment and control in the multi-ethnic study of atherosclerosis (MESA)
Am J Hypertens
(2004) - et al.
Effects of gender and ethnic group on blood pressure control in the elderly
Am J Hypertens
(1996) - et al.
Race, ethnicity, and sociocultural characteristics predict noncompliance with lipid-lowering medications
Prev Med
(2004) - et al.
A new method of classifying prognostic comorbidity in longitudinal studiesdevelopment and validation
J Chronic Dis
(1987) - et al.
Patient risk perceptions for carotid endarterectomywhich patients are strongly averse to surgery?
J Vasc Surg.
(2004) - et al.
The burden of adult hypertension in the United States 1999 to 2000A rising tide
Hypertension
(2004)
Contribution of major diseases to disparities in mortality
N Engl J Med
Advance report of final mortality statistics
Mon Vital Stat Rep
End-stage renal disease in African-American and white men16-year MRFIT findings
JAMA
Hypertension-related morbidity and mortality in the southeastern United States
Am J Med Sci
Prevalence of hypertension in the US adult populationresults from the third National Health and Nutrition Examination Survey. 1988-1991
Hypertension
Healthy People 2010
Racial differences in adherence to cardiac medications
J Natl Med Assoc
Compliance with antihypertensive therapy among elderly Medicaid enrolleesthe roles of age, gender, and race
Am J Public Health
Racean explanation of patient compliance—fact or fiction?
J Natl Med Assoc
Barriers and facilitators of medication adherence in hypertensive African Americansa qualitative study
Ethn Dis
Impact of medication nonadherence on coronary heart disease outcomesA critical review
Arch Intern Med
Medication adherence
Pharmacoeconomics of antihypertensive drug treatmentan analysis of how long patients remain on various antihypertensive therapies
J Clin Hypertens (Greenwich)
Patient compliance and angiotensin converting enzyme inhibitors in hypertension
J Cardiovasc Pharmacol
Long-term persistence with antihypertensive drugs in new patients
J Hum Hypertens
Compliance with antihypertensive regimena review of the research in the 1980s
Ann Behav Med
Adherence to medication
J Hum Hypertens
Time trends in high blood pressure control and the use of antihypertensive medications in older adultsthe cardiovascular health study
Arch Intern Med
Characteristics of patients with uncontrolled hypertension in the United States
N Engl J Med
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This research is supported by the Department of Veterans Affairs, Veterans Health Administration, HSR&D Service, investigator initiative grants 20-034 and 99-275. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.