Disparities in blood pressure control within a community-based provider network: an exploratory analysis

Abstract

Background: Despite treatment for hypertension, blood pressure (BP) remains uncontrolled in many individuals. Identification of patterns in BP control may inform strategies to improve treatment and optimize health outcomes.

Objective: To examine patterns in BP control among individuals receiving antihypertensive treatment in a diverse, community-based provider network.

Methods: In this retrospective exploratory analysis, a total of 51,772 hypertensive subjects were identified in the electronic medical record between January 1, 2007, and June 30, 2010, who were aged 18 years or older, with 2 or more claims for antihypertensive medication, documented race/ethnicity, and 1 or more documented BP readings.

Results: On the basis of Joint National Committee VII guidelines, 76.4% of nondiabetic patients had their BP controlled with treatment (<140/90 mm Hg) and 52.3% of those with diabetes had their BP controlled with treatment (<130/80 mm Hg). The overall rate of BP control was 71.4%. Factors associated with controlled BP included younger age, lower disease burden, better medication adherence, fewer concurrent prescriptions, lower prescription copayments, and living in a region with a higher median household income. Furthermore, when adjusting for age, sex, and disease burden, black (OR 0.68; 95% CI 0.62 to 0.75; p < 0.001), Hispanic (OR 0.80; 95% CI 0.74 to 0.86; p < 0.001), and other race/ethnic group (OR 0.81; 95% CI 0.70 to 0.94; p = 0.005) individuals were less likely than white individuals to have their treated BP controlled. Among nondiabetic hypertensive subjects with controlled BP, the most frequently prescribed therapy was a β-blocker or an angiotensin-converting enzyme (ACE) inhibitor across race/ethnicities; however, those who were black were most frequently prescribed a diuretic or calcium channel blocker. Among diabetic patients with controlled BP, the most frequently prescribed therapy was an ACE inhibitor, regardless of race/ethnicity.

Conclusions: Potential disparities, particularly among diabetic individuals and those of minority race/ethnicity, were found with regard to BP control and the agents used to treat hypertension. Future studies should address these disparities by designing interventions to improve the treatment of hypertension in high-risk populations.