Understanding racial disparities in treatment intensification for hypertension management

J Gen Intern Med. 2010 Aug;25(8):819-25. doi: 10.1007/s11606-010-1342-9. Epub 2010 Apr 13.


Background: Disparities in blood pressure (BP) control may be a function of disparities in treatment intensification (TI).

Objective: To examine racial differences in TI, understand modifiable factors that may mediate this relationship, and explore the relative effects of TI and race on blood pressure.

Design: Prospective cohort study.

Participants: Participants were 819 black and white patients with hypertension from an urban, safety-net hospital

Main measures: We sequentially explored the effects of patient race, sociodemographic and clinical characteristics, beliefs about BP/medications, perceptions of provider/discrimination, sodium intake, medication adherence, and provider counseling on TI, performing a series of random effects analyses. To assess the effects of race and TI on BP, we performed linear regressions, using systolic BP (SBP) as the outcome.

Key results: Unadjusted analyses and those including sociodemographic and clinical characteristics revealed that black patients had less TI than whites (-0.31 vs.-0.24, p < 0.001), but adjustment for patient beliefs and experiences eliminated the effects of race (beta =-0.02, p = 0.5). Increased patient concerns about BP medications were related to lower TI, as was more provider counseling (beta =-0.06, p = 0.02 and beta = -0.01, p = 0.001, respectively). In the unadjusted analysis, black race was a significant predictor of SBP (134 mm/Hg for blacks vs. 131 mm/Hg for whites, p = 0.009), but when both race and TI were included in the model, TI was a significant predictor of SBP (final SBP 2.0 mm/Hg lower for each additional therapy increase per 10 visits, p < 0.001), while race was not (Blacks 1.6 mm/Hg higher than whites, p = 0.17).

Conclusions: Improved patient-provider communication targeted towards addressing patient concerns about medications may have the potential to reduce racial disparities in TI and ultimately, BP control.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Antihypertensive Agents / therapeutic use*
  • Black or African American / statistics & numerical data*
  • Blood Pressure
  • Female
  • Health Knowledge, Attitudes, Practice
  • Healthcare Disparities*
  • Humans
  • Hypertension / drug therapy*
  • Linear Models
  • Male
  • Medication Adherence
  • Middle Aged
  • Multivariate Analysis
  • Prospective Studies
  • Statistics as Topic
  • Surveys and Questionnaires
  • White People / statistics & numerical data*


  • Antihypertensive Agents