Racial Differences and Social Determinants of Health in Achieving Hypertension Control

Milani, Richard V.; Price‐Haywood, Eboni G.; Burton, Jeffrey; Wilt, Jonathan K.; Entwisle, Jonathan; Lavie, Carl J.

doi:10.1016/j.mayocp.2022.01.035

Cited by 7 publications

(8 citation statements)

References 38 publications

(40 reference statements)

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“…40 In a retrospective study of 3305 patients with uncontrolled BP at baseline who enrolled in a hypertension digital medicine program, there was no difference in controlled BP at 1 year of follow-up between Black and White adults once 2 or more SDOH barriers to health care were present. 41 Prior National Health and Nutrition Examination Survey analyses showed evidence of a decrease in BP control among US adults with hypertension from 2013 to 2014 to 2017 to 2018, with persisting racial/ethnic disparities. 42 Although racial and ethnic disparities persist in SDOH factors, 9,10 there is a paucity of information on how the adverse effects of SDOH on racial/ethnic disparities in BP control have changed over the past 10 years.…”

Section: Discussionmentioning

confidence: 99%

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Social Determinants of Health and Uncontrolled Blood Pressure in a National Cohort of Black and White US Adults: the REGARDS Study

et al. 2023

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BACKGROUND: Determining the contribution of social determinants of health (SDOH) to the higher proportion of Black adults with uncontrolled blood pressure (BP) could inform interventions to improve BP control and reduce cardiovascular disease. METHODS: We analyzed data from 7306 White and 7497 Black US adults taking antihypertensive medication from the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study (2003–2007). SDOH were defined using the Healthy People 2030 domains of education, economic stability, social context, neighborhood environment, and health care access. Uncontrolled BP was defined as systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg. RESULTS: Among participants taking antihypertensive medication, 25.4% of White and 33.7% of Black participants had uncontrolled BP. The SDOH included in the current analysis mediated the Black-White difference in uncontrolled BP by 33.0% (95% CI, 22.1%–46.8%). SDOH that contributed to excess uncontrolled BP among Black compared with White adults included low annual household income (percent-mediated 15.8% [95% CI, 10.8%–22.8%]), low education (10.5% [5.6%–15.4%]), living in a health professional shortage area (10.4% [6.5%–14.7%]), disadvantaged neighborhood (11.0% [4.4%–18.0%]), and high-poverty zip code (9.7% [3.8%–15.5%]). Together, the neighborhood-domain accounted for 14.1% (95% CI, 5.9%–22.9%), the health care domain accounted for 12.7% (95% CI, 8.4%–17.3%), and the social-context-domain accounted for 3.8% (95% CI, 1.2%–6.6%) of the excess likelihood of uncontrolled BP among Black compared with White adults, respectively. CONCLUSIONS: SDOH including low education, low income, living in a health professional shortage area, disadvantaged neighborhood, and high-poverty zip code contributed to the excess likelihood of uncontrolled BP among Black compared with White adults.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Social Determinants of Health and Uncontrolled Blood Pressure in a National Cohort of Black and White US Adults: the REGARDS Study

et al. 2023

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“…23 For example, Black patients have reported several factors contributing to poor BP control, including limited HTN knowledge, cultural factors, racism-related stress, limited access to community resources and social determinants of health. [38][39][40] Structural factors contributing to racial disparities in telemedicine use for diabetes care has been described previously. 41 Accordingly, non-White patients will need proper support for effective TM-HTN use.…”

Section: Discussionmentioning

confidence: 99%

Heterogeneity of the Effect of Telemedicine Hypertension Management Approach on Blood Pressure: A Systematic Review and Meta-analysis of US-based Clinical Trials

Acharya,

Neupane,

Seals

et al. 2023

Preprint

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Background: Telemedicine management of hypertension (TM-HTN) uses home blood pressure (BP) to guide pharmacotherapy and telemedicine-based self-management support (SMS). Optimal approach to implementing TM-HTN in the US is unknown. Methods We conducted a systematic review and a meta-analysis to examine the effect of TM-HTN vs. usual clinic-based care on BP and assessed heterogeneity by patient- and clinician-related factors. We searched US-based randomized clinical trials among adults from Medline, Embase, CENTRAL, CINAHL, PsycInfo, and Compendex, Web of Science Core Collection, Scopus, and two trial registries to 7/7/2023. Two authors extracted, and a third author confirmed data. We used trial-level differences in systolic BP (SBP), diastolic BP (DBP) and BP control rate at ?6 months using random-effects models. We examined heterogeneity of effect in univariable meta-regression and in pre-specified subgroups [clinicians leading pharmacotherapy (physician vs. non-physician), SMS (pharmacist vs. nurse), White vs. non-White patient predominant trials (>50% patients/trial), diabetes predominant trials (≥25% patients/trial) and in trials that have majority of both non-White patients and patients with diabetes vs. White patient predominant but not diabetes predominant trials. Results : Thirteen, 11 and 7 trials were eligible for SBP, DBP and BP control, respectively. Differences in SBP, DBP and BP control rate were -7.3 mmHg (95% CI: -9.4, -5.2), -2.7 mmHg (-4.0, -1.5) and 10.1% (0.4%, 19.9%), respectively, favoring TM-HTN. More BP reduction occurred in trials with non-physician vs. physician led pharmacotherapy (9.3/4.0 mmHg vs. 4.9/1.1 mmHg, P<0.01 for both SBP/DBP), pharmacist vs. nurses provided SMS (9.3/4.1 mmHg vs. 5.6/1.0 mmHg, P=0.01 for SBP, P<0.01 for DBP), and White vs. non-White patient predominant trials (9.3/4.0 mmHg vs. 4.4/1.1 mmHg, P<0.01 for both SBP/DBP), with no difference by diabetes predominant trials. Lower BP reduction occurred in both diabetes and non-White patient predominant trials vs. White patient predominant but not diabetes predominant trials (4.5/0.9 mmHg vs. 9.5/4.2 mmHg, P<0.01 for both SBP/DBP). Conclusions TM-HTN is more effective than clinic-based care in the US, particularly when non-physician led pharmacotherapy and pharmacist provided SMS. Non-White patient predominant trials seemed to achieve lesser BP reduction. Equity conscious, locally informed adaptation of TM-HTN is needed before wider implementation.

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“…In a retrospective study (n ¼ 3305), health barriers were more prevalent in black than in white patients [44.6% (482 of 1081) vs. 31.3% (674 of 2150)] [31]. Moreover, when multiple health barriers were present, BP control was no longer different in white versus black patients [31].…”

Section: Telemedicine and Self-measured Blood Pressure: Emerging Tool...mentioning

confidence: 99%

“…In a large integrated healthcare system, the Ochsner Hypertension Digital Medicine Program improved enrolee's BP, medication adherence, and healthcare utilization [30 ▪ ]. In a retrospective study ( n = 3305), health barriers were more prevalent in black than in white patients [44.6% (482 of 1081) vs. 31.3% (674 of 2150)] [31]. Moreover, when multiple health barriers were present, BP control was no longer different in white versus black patients [31].…”

Section: Telemedicine and Self-measured Blood Pressure: Emerging Tool...mentioning

confidence: 99%

Eliminating hypertension disparities in U.S. non-Hispanic black adults: current and emerging interventions

Ferdinand

Charbonnet

Laurent

et al. 2023

Current Opinion in Cardiology

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Purpose of reviewHypertension in non-Hispanic black (NHB) adults in the United States has an earlier onset, higher prevalence, and increased severity compared with other racial/ethnic populations. Uncontrolled hypertension is responsible for the increased burden of cardiovascular disease (CVD) morbidity and mortality and decreased longevity in NHB adults. Unfortunately, eliminating the persistent hypertensionassociated disparities and the white/black mortality gap, worsened by the COVID-19 pandemic, has been challenging. Overcoming the social determinants of health (SDOH), implementing therapeutic lifestyle changes (TLC), and using intensive guideline-directed medical therapy are required. Moreover, novel approaches, including community-based interventions and self-measured blood pressure (SMBP) monitoring, may mitigate U.S. disparities in hypertension. Recent findingsIn this review, we discuss recent data regarding the U.S. NHB adult disparate hypertension control and CVD morbidity and mortality. We note current approaches to address disparities, such as TLC, evidencebased pharmacotherapy, community-based interventions and SMBP. Finally, we explore future research and initiatives to seek hypertension-related health equity.

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Racial Differences and Social Determinants of Health in Achieving Hypertension Control

Cited by 7 publications

References 38 publications

Social Determinants of Health and Uncontrolled Blood Pressure in a National Cohort of Black and White US Adults: the REGARDS Study

Social Determinants of Health and Uncontrolled Blood Pressure in a National Cohort of Black and White US Adults: the REGARDS Study

Heterogeneity of the Effect of Telemedicine Hypertension Management Approach on Blood Pressure: A Systematic Review and Meta-analysis of US-based Clinical Trials

Eliminating hypertension disparities in U.S. non-Hispanic black adults: current and emerging interventions

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