Two studies in the current issue examine ethnic and racial disparities in hypertension care and control, and accompanying commentaries from three distinguished editorialists amplify and elucidate this important topic.
In the first study, Fiscella and Holt find that racial disparities in blood pressure control contribute to nearly 8,000 preventable deaths from heart disease and stroke among blacks every year. In what is thought to be the first study to quantify the toll of racial disparities in blood pressure control, researchers analyzed nationally representative data on 2,770 black and white adults, as well as meta-analyses of observational studies and treatment trials for systolic blood pressure. They found that the average systolic blood pressure among blacks with hypertension was approximately 7 mm Hg higher than that for whites with hypertension. Moreover, they found that a reduction in the average systolic blood pressure among hypertensive blacks to that of hypertensive whites would reduce the annual number of black deaths from heart disease by 5,590 and from stroke by 2,190. They suggest that primary care clinicians should be particularly diligent when managing hypertension in black patients and should focus their efforts on addressing patients' adherence barriers.
In the second article, Millet and colleagues find disparities in medication prescribing and blood pressure control between ethnic groups in England despite major investment in quality improvement initiatives and a health care system that offers universal access. Researchers analyzed data on 8,876 patients from family practices in southwest London after the implementation of a major pay-for-performance program that placed considerable emphasis on improving the quality of care for individuals with cardiovascular disease. They found black patients with hypertension had significantly higher average blood pressure values and were significantly less likely to achieve an established treatment target for blood pressure control than white or South Asian patients. Moreover, they found disparities were particularly marked among those patients with multiple cardiovascular conditions, who arguably may be the sickest patients. They conclude that large-scale quality improvement programs may require additional components to improve the quality of care of high-risk individuals, including those from minority ethnic groups.
Accompanying editorials from Former U.S. Surgeon General David Satcher, M.D., Ph.D., and Crystal Wile Cené, M.D., M.P.H., and Lisa A. Cooper, M.D., M.P.H., call on clinicians, researchers, health care administrators, health care planners and policy makers to work together to gain a better understanding of the barriers faced by ethnic minorities and develop comprehensive strategies to overcome them.
Racial Disparity in Hypertension Control: The Death Toll
By Kevin Fiscella, M.D., M.P.H., and Kathleen Holt, Ph.D.
University of Rochester School of Medicine and Dentistry, New York
Ethnic Disparities in Blood Pressure Management in Patients with Hypertension After the Introduction of Pay for Performance
By Christopher Millett, M.Sc., F.F.P.H., et al
Imperial College Faculty of Medicine, London
Examining Racial and Ethnic Disparities in Health and Hypertension Control
By David Satcher, M.D., Ph.D.
Morehouse School of Medicine, Atlanta, Georgia
Death Toll From Uncontrolled Blood Pressure in Ethnic Populations: Universal Access and Quality Improvement May Not Be Enough
Crystal Wile Cené, M.D., M.P.H., and Lisa A. Cooper, M.D., M.P.H.
University of North Carolina at Chapel Hill
Johns Hopkins School of Medicine, Baltimore, Maryland
Annals of Family Medicine - November/December 2008
The Annals of Family Medicine is a new peer-reviewed research journal to meet the needs of scientists, practitioners, policymakers, and the patients and communities they serve. The Annals of Family Medicine is dedicated to advancing knowledge essential to understanding and improving health and primary care. The Annals supports a learning community of those who generate and use information about health and generalist health care.
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Angela Sharma
American Academy of Family Physicians