Disparity Among Black, White Adults With Uncontrolled Blood Pressure

A higher proportion of non-Hispanic Black patients still have uncontrolled blood pressure (BP) compared to non-Hispanic White patients, according to a study published in JAMA Network Open.

“The disparity in BP control between Black and White patients was reduced although not eliminated following the implementation of a [quality improvement (QI)] program aimed at reducing disparities in BP control between Black and White patients,” the study authors wrote.

Between 2008 and 2019, hypertension, which is the leading preventable risk factor for cardiovascular disease (CVD), increased among female, Black, and White patients.

Researchers at Kaiser Permanente Southern California (KPSC) conducted a difference-in-difference analysis to assess the effects of a hypertension QI initiative on BP among Black and White patients. Age, sex, race, and ethnicity were factors that were also measured.

After the QI initiative, 33.8% of Black patients obtained control of their BP. Among White patients, this proportion was 38.3%. Young Black males aged 18 to 49 years were among those who had the hardest time reaching BP control each year. Conversely, Black male patients 65 years of age and older had the most BP control from the pre- to post-QI program period.

Although similar proportions of Black and White hypertensive patients received antihypertensive medications, more Black patients were treated with 3 or more prescriptions. Despite taking a higher prescription count, a greater proportion of Black patients had uncontrolled BP, which may stem from “lower medication adherence, environmental issues, and lifestyle factors.”

The proportion of patients on an antihypertensive medication for BP control increased from 2008 to 2019, with the number of Black patients controlling BP with medication growing from 70.5% to 78.4% compared with an increase of 76.3% to 81.2% among White patients. Researchers did note that 1 to 3 medications curbed high BP in general.

Despite young Black men aged 18-49 years not gaining as much BP control on a yearly basis, they did experience one of the largest reductions in BP control disparity against White males of the same age. Black and White females aged 50 to 64 years also had one of the largest decreases in disparity gap.

The trial includes limitations, the foremost of which being that the data only account for insured patients, which limited generalizability to uninsured individuals/populations. Additionally, the researchers defined BP control only by the last BP measurement in the previous year. Further, hypertension cases could be underestimated because of patients who were not diagnosed at outpatient or hospital visits.

The CDC lists resources to improve hypertension awareness, treatment, and control on their website. Other health care organizations are encouraged to raised awareness about increasing BP management and prevention strategies to prevent hypertension and CVD occurrence.

“These findings suggest more focused interventions may be needed to increase BP control among Black patients even in an integrated health care setting,” the study authors wrote.

Reference

Harrison, Teresa, Zhou, Hui, Wei, Rong, et al. Blood Pressure Control Among Black and White Adults Following a Quality Improvement Program in a Large Integrated Health System. JAMA Netw Open. 2023;6(1):e2249930. doi:10.1001/jamanetworkopen.2022.49930