Race-Specific Patterns of Treatment Intensification Among Hypertensive Patients Using Home Blood Pressure Monitoring: Analysis Using Defined Daily Doses in the Heart Healthy Lenoir Study

Overview

Journal Ann Pharmacother

Specialty Pharmacology

Date 2018 Oct 5

PMID 30282468

Citations 4

Authors

Doyle M Cummings

Alyssa Adams

Jacquie Halladay

Alan Hinderliter

Katrina E Donahue

Crystal W Cene

Quefeng Li

Cassandra Miller

Beverly Garcia

Jim Tillman

Edwin Little

Darren DeWalt

Affiliations

Soon will be listed here.

Abstract

Background: Racial disparities in blood pressure (BP) control persist, but whether differences by race in antihypertensive medication intensification (AMI) contribute is unknown.

Objective: To compare AMI by race for patients with elevated home BP readings.

Methods: This prospective cohort study followed adult patients from 6 rural primary care practices who used home BP monitoring (HBPM) and recorded/reported values. For providers, AMI was encouraged when mean HBPM systolic blood pressure (SBP) values were ⩾135 mm Hg; patients received phone-based coaching on HBPM technique and sharing HBPM findings. AMI was assessed between baseline and 12 months using defined daily dose (DDD) and summed to create a total antihypertensive DDD value.

Results: A total of 217 patients (mean age = 61.4 ± 10.2 years; 66% female; 57% black) provided usable HBPM data. Among 90 (41%) intensification-eligible hypertensive patients (ie, mean HBPM SBP values for 6-months ⩾135 mm Hg), mean total antihypertensive DDD was increased in 61% at 12 months. Blacks had significantly higher mean DDD at baseline and 12 months, but intensification (+0.72 vs +0.65; P = 0.83) was similar by race. However, intensification was greater in males than females (+1.1 vs +0.39; P = 0.031). Reduction in mean SBP following intensification was greater in white versus black patients (-8.2 vs -3.9 mm Hg; P = 0.14). Conclusion/Relevance: Treatment intensification in HBPM users was similar by race, differed significantly by gender, and may produce a greater response in white patients. Differential AMI in HBPM users does not appear to contribute to persistent racial disparities in BP control.

Citing Articles

Treatment Intensity, Prescribing Patterns, and Blood Pressure Control in Rural Black Patients with Uncontrolled Hypertension.

Cummings D, Adams A, Patil S, Cherrington A, Halladay J, Oparil S J Racial Ethn Health Disparities. 2022; 10(5):2505-2512.

PMID: 36271193 DOI: 10.1007/s40615-022-01431-2.

Intensifying approaches to address clinical inertia among cardiovascular disease risk factors: A narrative review.

Lewinski A, Jazowski S, Goldstein K, Whitney C, Bosworth H, Zullig L Patient Educ Couns. 2022; 105(12):3381-3388.

PMID: 36002348 PMC: 9675717. DOI: 10.1016/j.pec.2022.08.005.

Use of Self-Measured Blood Pressure Monitoring to Improve Hypertension Equity.

Khoong E, Commodore-Mensah Y, Lyles C, Fontil V Curr Hypertens Rep. 2022; 24(11):599-613.

PMID: 36001268 PMC: 9399977. DOI: 10.1007/s11906-022-01218-0.

Association of Differences in Treatment Intensification, Missed Visits, and Scheduled Follow-up Interval With Racial or Ethnic Disparities in Blood Pressure Control.

Fontil V, Pacca L, Bellows B, Khoong E, McCulloch C, Pletcher M JAMA Cardiol. 2021; 7(2):204-212.

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