Disparities in Blood Pressure Control Within a Community-Based Provider Network: An Exploratory Analysis
Background: Despite treatment for hypertension, blood pressure (BP) remains uncontrolled in many individuals. Identification of patterns in BP control may inform strategies to improve treatment and optimize health outcomes. Objective: To examine patterns in BP control among individuals receiving ant...
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| Veröffentlicht in: | The Annals of pharmacotherapy 2011-12, Vol.45 (12), p.1473-1482 |
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| container_title | The Annals of pharmacotherapy |
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| creator | Romanelli, Robert J Schiro, Timothy A Jukes, Trevor Wong, Ken S Ishisaka, Denis Y |
| description | Background:
Despite treatment for hypertension, blood pressure (BP) remains uncontrolled in many individuals. Identification of patterns in BP control may inform strategies to improve treatment and optimize health outcomes.
Objective:
To examine patterns in BP control among individuals receiving antihypertensive treatment in a diverse, community-based provider network.
Methods:
In this retrospective exploratory analysis, a total of 51.772 hypertensive subjects were identified in the electronic medical record between January 1, 2007, and June 30, 2010, who were aged 18 years or older, with 2 or more claims for antihypertensive medication, documented race/ethnicity, and 1 or more documented BP readings.
Results:
On the basis of Joint National Committee VII guidelines, 76.4% of nondiabetic patients had their BP controlled with treatment ( |
| doi_str_mv | 10.1345/aph.1Q523 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_911929806</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1345_aph.1Q523</sage_id><sourcerecordid>911929806</sourcerecordid><originalsourceid>FETCH-LOGICAL-c275t-c9a22627247c49875b697addcf29255003f253b168974f33fb2d26e083355933</originalsourceid><addsrcrecordid>eNpt0MlOwzAQBmALgSjbgRdAuQDikGKP4yTmBmWVKhYJiWPkJg51SeLgSYC-PYYWuHDy2PNpPPoJ2WV0yHgkjlU7HbIHAXyFbDARQRhDQld9TWMaUkjpgGwiziilkoFcJwMAFiUsEhtkem6wVc50RmNgmuCssrYI7p1G7J0ORrbpnK2CJ9NNfVf5h7ruG9PNwzOF-kvaN1NoF9zq7t26l5PgtAkuPtrKOtVZN_dXVc3R4DZZK1WFemd5bpHHy4vH0XU4vru6GZ2OwxwS0YW5VAB-fYiSPJJpIiaxTFRR5CVIEIJSXoLgExanMolKzssJFBBrmnIuhOR8ixwuxrbOvvYau6w2mOuqUo22PWaSMQkypbGXRwuZO4vodJm1ztTKzTNGs69YMx9r9h2rt3vLqf2k1sWv_MnRg_0lUJirqnSqyQ3-OeHXSxnz7mDhUD3rbGZ75-PBf378BOQEi5w</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>911929806</pqid></control><display><type>article</type><title>Disparities in Blood Pressure Control Within a Community-Based Provider Network: An Exploratory Analysis</title><source>SAGE Publications</source><source>MEDLINE</source><creator>Romanelli, Robert J ; Schiro, Timothy A ; Jukes, Trevor ; Wong, Ken S ; Ishisaka, Denis Y</creator><creatorcontrib>Romanelli, Robert J ; Schiro, Timothy A ; Jukes, Trevor ; Wong, Ken S ; Ishisaka, Denis Y</creatorcontrib><description>Background:
Despite treatment for hypertension, blood pressure (BP) remains uncontrolled in many individuals. Identification of patterns in BP control may inform strategies to improve treatment and optimize health outcomes.
Objective:
To examine patterns in BP control among individuals receiving antihypertensive treatment in a diverse, community-based provider network.
Methods:
In this retrospective exploratory analysis, a total of 51.772 hypertensive subjects were identified in the electronic medical record between January 1, 2007, and June 30, 2010, who were aged 18 years or older, with 2 or more claims for antihypertensive medication, documented race/ethnicity, and 1 or more documented BP readings.
Results:
On the basis of Joint National Committee VII guidelines, 76.4% of nondiabetic patients had their BP controlled with treatment (<140/90 mm Hg) and 52.3% of those with diabetes had their BP controlled with treatment (<130/80 mm Hg). The overall rate of BP control was 71.4%. Factors associated with controlled BP included younger age, lower disease burden, better medication adherence, fewer concurrent prescriptions, lower prescription copayments, and living in a region with a higher median household income. Furthermore, when adjusting for age, sex, and disease burden, black (OR 0.68; 95% Cl 0.62 to 0.75; p < 0.001), Hispanic (OR 0.80; 95% Cl 0.74 to 0.86; p < 0.001), and other race/ethnic group (OR 0.81; 95% Cl 0.70 to 0.94; p = 0.005) individuals were less likely than white individuals to have their treated BP controlled. Among nondiabetic hypertensive subjects with controlled BP, the most frequently prescribed therapy was a β-blocker or an angiotensin-converting enzyme (ACE) inhibitor across race/ethnicities; however, those who were black were most frequently prescribed a diuretic or calcium channel blocker. Among diabetic patients with controlled BP, the most frequently prescribed therapy was an ACE inhibitor, regardless of race/ethnicity.
Conclusions:
Potential disparities, particularly among diabetic individuals and those of minority race/ethnicity, were found with regard to BP control and the agents used to treat hypertension. Future studies should address these disparities by designing interventions to improve the treatment of hypertension in high-risk populations.</description><identifier>ISSN: 1060-0280</identifier><identifier>EISSN: 1542-6270</identifier><identifier>DOI: 10.1345/aph.1Q523</identifier><identifier>PMID: 22147145</identifier><identifier>CODEN: APHRER</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Adolescent ; Adult ; Aged ; Antihypertensive Agents - therapeutic use ; Arterial hypertension. Arterial hypotension ; Biological and medical sciences ; Blood and lymphatic vessels ; Blood Pressure - drug effects ; Cardiology. Vascular system ; Community Health Services ; Cross-Sectional Studies ; Diabetes Mellitus - drug therapy ; Diabetes Mellitus - ethnology ; Diabetes. Impaired glucose tolerance ; Electronic Health Records ; Endocrine pancreas. Apud cells (diseases) ; Endocrinopathies ; Etiopathogenesis. Screening. Investigations. Target tissue resistance ; Female ; Healthcare Disparities - ethnology ; Healthcare Disparities - statistics & numerical data ; Humans ; Hypertension - drug therapy ; Hypertension - ethnology ; Male ; Medical sciences ; Middle Aged ; Pharmacology. Drug treatments ; Retrospective Studies ; Young Adult</subject><ispartof>The Annals of pharmacotherapy, 2011-12, Vol.45 (12), p.1473-1482</ispartof><rights>2011 SAGE Publications</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c275t-c9a22627247c49875b697addcf29255003f253b168974f33fb2d26e083355933</citedby><cites>FETCH-LOGICAL-c275t-c9a22627247c49875b697addcf29255003f253b168974f33fb2d26e083355933</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1345/aph.1Q523$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1345/aph.1Q523$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,780,784,21818,27923,27924,43620,43621</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25335811$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22147145$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Romanelli, Robert J</creatorcontrib><creatorcontrib>Schiro, Timothy A</creatorcontrib><creatorcontrib>Jukes, Trevor</creatorcontrib><creatorcontrib>Wong, Ken S</creatorcontrib><creatorcontrib>Ishisaka, Denis Y</creatorcontrib><title>Disparities in Blood Pressure Control Within a Community-Based Provider Network: An Exploratory Analysis</title><title>The Annals of pharmacotherapy</title><addtitle>Ann Pharmacother</addtitle><description>Background:
Despite treatment for hypertension, blood pressure (BP) remains uncontrolled in many individuals. Identification of patterns in BP control may inform strategies to improve treatment and optimize health outcomes.
Objective:
To examine patterns in BP control among individuals receiving antihypertensive treatment in a diverse, community-based provider network.
Methods:
In this retrospective exploratory analysis, a total of 51.772 hypertensive subjects were identified in the electronic medical record between January 1, 2007, and June 30, 2010, who were aged 18 years or older, with 2 or more claims for antihypertensive medication, documented race/ethnicity, and 1 or more documented BP readings.
Results:
On the basis of Joint National Committee VII guidelines, 76.4% of nondiabetic patients had their BP controlled with treatment (<140/90 mm Hg) and 52.3% of those with diabetes had their BP controlled with treatment (<130/80 mm Hg). The overall rate of BP control was 71.4%. Factors associated with controlled BP included younger age, lower disease burden, better medication adherence, fewer concurrent prescriptions, lower prescription copayments, and living in a region with a higher median household income. Furthermore, when adjusting for age, sex, and disease burden, black (OR 0.68; 95% Cl 0.62 to 0.75; p < 0.001), Hispanic (OR 0.80; 95% Cl 0.74 to 0.86; p < 0.001), and other race/ethnic group (OR 0.81; 95% Cl 0.70 to 0.94; p = 0.005) individuals were less likely than white individuals to have their treated BP controlled. Among nondiabetic hypertensive subjects with controlled BP, the most frequently prescribed therapy was a β-blocker or an angiotensin-converting enzyme (ACE) inhibitor across race/ethnicities; however, those who were black were most frequently prescribed a diuretic or calcium channel blocker. Among diabetic patients with controlled BP, the most frequently prescribed therapy was an ACE inhibitor, regardless of race/ethnicity.
Conclusions:
Potential disparities, particularly among diabetic individuals and those of minority race/ethnicity, were found with regard to BP control and the agents used to treat hypertension. Future studies should address these disparities by designing interventions to improve the treatment of hypertension in high-risk populations.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Antihypertensive Agents - therapeutic use</subject><subject>Arterial hypertension. Arterial hypotension</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Blood Pressure - drug effects</subject><subject>Cardiology. Vascular system</subject><subject>Community Health Services</subject><subject>Cross-Sectional Studies</subject><subject>Diabetes Mellitus - drug therapy</subject><subject>Diabetes Mellitus - ethnology</subject><subject>Diabetes. Impaired glucose tolerance</subject><subject>Electronic Health Records</subject><subject>Endocrine pancreas. Apud cells (diseases)</subject><subject>Endocrinopathies</subject><subject>Etiopathogenesis. Screening. Investigations. Target tissue resistance</subject><subject>Female</subject><subject>Healthcare Disparities - ethnology</subject><subject>Healthcare Disparities - statistics & numerical data</subject><subject>Humans</subject><subject>Hypertension - drug therapy</subject><subject>Hypertension - ethnology</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Pharmacology. Drug treatments</subject><subject>Retrospective Studies</subject><subject>Young Adult</subject><issn>1060-0280</issn><issn>1542-6270</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpt0MlOwzAQBmALgSjbgRdAuQDikGKP4yTmBmWVKhYJiWPkJg51SeLgSYC-PYYWuHDy2PNpPPoJ2WV0yHgkjlU7HbIHAXyFbDARQRhDQld9TWMaUkjpgGwiziilkoFcJwMAFiUsEhtkem6wVc50RmNgmuCssrYI7p1G7J0ORrbpnK2CJ9NNfVf5h7ruG9PNwzOF-kvaN1NoF9zq7t26l5PgtAkuPtrKOtVZN_dXVc3R4DZZK1WFemd5bpHHy4vH0XU4vru6GZ2OwxwS0YW5VAB-fYiSPJJpIiaxTFRR5CVIEIJSXoLgExanMolKzssJFBBrmnIuhOR8ixwuxrbOvvYau6w2mOuqUo22PWaSMQkypbGXRwuZO4vodJm1ztTKzTNGs69YMx9r9h2rt3vLqf2k1sWv_MnRg_0lUJirqnSqyQ3-OeHXSxnz7mDhUD3rbGZ75-PBf378BOQEi5w</recordid><startdate>20111201</startdate><enddate>20111201</enddate><creator>Romanelli, Robert J</creator><creator>Schiro, Timothy A</creator><creator>Jukes, Trevor</creator><creator>Wong, Ken S</creator><creator>Ishisaka, Denis Y</creator><general>SAGE Publications</general><general>Whitney</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20111201</creationdate><title>Disparities in Blood Pressure Control Within a Community-Based Provider Network: An Exploratory Analysis</title><author>Romanelli, Robert J ; Schiro, Timothy A ; Jukes, Trevor ; Wong, Ken S ; Ishisaka, Denis Y</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c275t-c9a22627247c49875b697addcf29255003f253b168974f33fb2d26e083355933</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Antihypertensive Agents - therapeutic use</topic><topic>Arterial hypertension. Arterial hypotension</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Blood Pressure - drug effects</topic><topic>Cardiology. Vascular system</topic><topic>Community Health Services</topic><topic>Cross-Sectional Studies</topic><topic>Diabetes Mellitus - drug therapy</topic><topic>Diabetes Mellitus - ethnology</topic><topic>Diabetes. Impaired glucose tolerance</topic><topic>Electronic Health Records</topic><topic>Endocrine pancreas. Apud cells (diseases)</topic><topic>Endocrinopathies</topic><topic>Etiopathogenesis. Screening. Investigations. Target tissue resistance</topic><topic>Female</topic><topic>Healthcare Disparities - ethnology</topic><topic>Healthcare Disparities - statistics & numerical data</topic><topic>Humans</topic><topic>Hypertension - drug therapy</topic><topic>Hypertension - ethnology</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Pharmacology. Drug treatments</topic><topic>Retrospective Studies</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Romanelli, Robert J</creatorcontrib><creatorcontrib>Schiro, Timothy A</creatorcontrib><creatorcontrib>Jukes, Trevor</creatorcontrib><creatorcontrib>Wong, Ken S</creatorcontrib><creatorcontrib>Ishisaka, Denis Y</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Annals of pharmacotherapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Romanelli, Robert J</au><au>Schiro, Timothy A</au><au>Jukes, Trevor</au><au>Wong, Ken S</au><au>Ishisaka, Denis Y</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Disparities in Blood Pressure Control Within a Community-Based Provider Network: An Exploratory Analysis</atitle><jtitle>The Annals of pharmacotherapy</jtitle><addtitle>Ann Pharmacother</addtitle><date>2011-12-01</date><risdate>2011</risdate><volume>45</volume><issue>12</issue><spage>1473</spage><epage>1482</epage><pages>1473-1482</pages><issn>1060-0280</issn><eissn>1542-6270</eissn><coden>APHRER</coden><abstract>Background:
Despite treatment for hypertension, blood pressure (BP) remains uncontrolled in many individuals. Identification of patterns in BP control may inform strategies to improve treatment and optimize health outcomes.
Objective:
To examine patterns in BP control among individuals receiving antihypertensive treatment in a diverse, community-based provider network.
Methods:
In this retrospective exploratory analysis, a total of 51.772 hypertensive subjects were identified in the electronic medical record between January 1, 2007, and June 30, 2010, who were aged 18 years or older, with 2 or more claims for antihypertensive medication, documented race/ethnicity, and 1 or more documented BP readings.
Results:
On the basis of Joint National Committee VII guidelines, 76.4% of nondiabetic patients had their BP controlled with treatment (<140/90 mm Hg) and 52.3% of those with diabetes had their BP controlled with treatment (<130/80 mm Hg). The overall rate of BP control was 71.4%. Factors associated with controlled BP included younger age, lower disease burden, better medication adherence, fewer concurrent prescriptions, lower prescription copayments, and living in a region with a higher median household income. Furthermore, when adjusting for age, sex, and disease burden, black (OR 0.68; 95% Cl 0.62 to 0.75; p < 0.001), Hispanic (OR 0.80; 95% Cl 0.74 to 0.86; p < 0.001), and other race/ethnic group (OR 0.81; 95% Cl 0.70 to 0.94; p = 0.005) individuals were less likely than white individuals to have their treated BP controlled. Among nondiabetic hypertensive subjects with controlled BP, the most frequently prescribed therapy was a β-blocker or an angiotensin-converting enzyme (ACE) inhibitor across race/ethnicities; however, those who were black were most frequently prescribed a diuretic or calcium channel blocker. Among diabetic patients with controlled BP, the most frequently prescribed therapy was an ACE inhibitor, regardless of race/ethnicity.
Conclusions:
Potential disparities, particularly among diabetic individuals and those of minority race/ethnicity, were found with regard to BP control and the agents used to treat hypertension. Future studies should address these disparities by designing interventions to improve the treatment of hypertension in high-risk populations.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>22147145</pmid><doi>10.1345/aph.1Q523</doi><tpages>10</tpages></addata></record> |
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| ispartof | The Annals of pharmacotherapy, 2011-12, Vol.45 (12), p.1473-1482 |
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| subjects | Adolescent Adult Aged Antihypertensive Agents - therapeutic use Arterial hypertension. Arterial hypotension Biological and medical sciences Blood and lymphatic vessels Blood Pressure - drug effects Cardiology. Vascular system Community Health Services Cross-Sectional Studies Diabetes Mellitus - drug therapy Diabetes Mellitus - ethnology Diabetes. Impaired glucose tolerance Electronic Health Records Endocrine pancreas. Apud cells (diseases) Endocrinopathies Etiopathogenesis. Screening. Investigations. Target tissue resistance Female Healthcare Disparities - ethnology Healthcare Disparities - statistics & numerical data Humans Hypertension - drug therapy Hypertension - ethnology Male Medical sciences Middle Aged Pharmacology. Drug treatments Retrospective Studies Young Adult |
| title | Disparities in Blood Pressure Control Within a Community-Based Provider Network: An Exploratory Analysis |
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