Disparities in Hypertension Control Lead to the Deaths of 8,000 African Americans Each Year

Study results published recently by researchers from the University of Rochester Medical Center revealed that disparities in the care and treatment for hypertension provided to white and African American patients contributes to the deaths of almost 8,000 African American men and women in the United States each year.

According to a University of Rochester Medical Center press release, the researchers concluded that “the deaths could be avoided or postponed if blacks had their hypertension, or high blood pressure, controlled to the same level as whites.”

Kevin Fiscella, MD, MPH, lead author of the article published in the November/December 2008 issue of the Annals of Family Medicine, and associate professor of family medicine and of community and preventive medicine at University of Rochester Medical Center, said that “Disparity in the control of blood pressure is one of the most important, if not the most important, contributor to racial disparity in cardiovascular mortality, and probably overall mortality.”

The authors of the article said that the causes of racial disparity in blood pressure control are unknown, but point to several possible explanations, including differences in access to care, clinician management, hypertension severity, and patient adherence to prescribed treatment regimens.

Contributing factors to differences in adherence by race identified in the study include “affordability of medicines, personal beliefs, anticipated adverse effects, and health literacy that disproportionately affect blacks.”

Fiscella also stated that “There is evidence from previous studies that access barriers and financial and interpersonal communication barriers affect the ability of black patients to get medical care or to take their medication as prescribed.”

In the journal article, the authors also note that, while “it is possible that blacks have more severe hypertension or respond less favorably to antihypertensive drugs,” there is “no clear evidence” for racial differences in severity, and analysis of data from clinical trials show a “similar response to antihypertensive medication by race, with whites having a slightly greater response to β-blockers and blacks having a slightly greater response to diuretics.”

The authors claim that “although multiple causes may contribute to racial disparity in blood pressure control, this disparity is not inevitable. Disparity in hypertension control is significantly smaller in the Veterans Administration Health System, where access barriers are fewer.”