Black Patients Less Likely to Receive Treatment Intensification for BP Control

Nearly one-third of racial disparities in treatment of hypertension may be a result of inequities in treatment intensification, according to preliminary research to be presented at the virtual American Heart Association (AHA) Scientific Sessions 2020, Friday November 13 through Tuesday November 17.

“Missed opportunities for increasing therapy may be one of the most significant contributors to racial disparities in blood pressure outcomes that may, in turn, contribute to poor health for Black Americans,” said Valy Fontil, MD, MAS, assistant professor of medicine at the University of California San Francisco (UCSF) and first author of the study, in an AHA press release.

Fontil and colleagues designed their study to determine to what extent variation in healthcare processes – such as treatment intensification and missed office visits – explain the disparity in blood pressure outcomes. They hypothesized that missed clinical visits would mediate a more sizable percentage of BP control disparities.

The Study

They examined data from 2015 to 2017 for >15 000 patients treated for hypertension at 12 San Francisco safety-net clinics. Patients were diagnosed with hypertension and had at least one clinic visit with uncontrolled blood pressure (≥140/90 mm Hg). The average age of patients was 58; 50% were women; and diverse ethnic groups were represented: 29% Asian, 23% Black, 24% Hispanic, and 17% white adults.

Results

• Black participants had more missed opportunities for treatment intensification (β=-0.02, p<.001) and missed more clinic appointments (β=0.37, p<.001) vs other racial groups.
• After accounting for these differences, black patients remained less likely than whites to achieve BP control (β=0.16, OR=0.85, 95% CI=0.76-0.95).
• Lower treatment intensification accounted for 28% and missed clinic visits for 14% of the total effect of Black race on BP control.
• Additional or intensified treatment for BP control was lower in Black patients and higher in Asian Americans than in the other racial groups.

Study co-author Lucia Pacca, PhD, a research associate at UCSF, points out in the AHA release that their study’s finding confirm what has been observed in the past – that Black patients are least likely and Asian Americans most likely to achieve normal BP. What was most surprising was that “this racial difference appears to be explained by whether patients received additional or intensified therapy for high blood pressure.”

While research has shown that treatment decisions for some conditions, notably pain, can vary based on patient’s race and physician bias, it has not been widely reported for hypertension treatment, Fontil notes in the release.

“Achieving blood pressure control in the U.S. still relies on decisions made by clinicians and patients during the clinical encounter,” said Kirsten Bibbins-Domingo, PhD, MAS, chair of the department of epidemiology and biostatistics at UCSF and senior author of the study, in the statement. “More research is necessary to explain why there are such variations in these decisions to intensify therapy.”

Source MP269 - Impact of Racial Differences in Treatment Intensification and Missed Visits on Disparities in BP Control​