• Meredith Manze, Adam J Rose, Michelle B Orner, Dan R Berlowitz, and Nancy R Kressin.
• Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA. meredith.manze@bmc.org
• J Gen Intern Med. 2010 Aug 1; 25 (8): 819825819-25.

BackgroundDisparities in blood pressure (BP) control may be a function of disparities in treatment intensification (TI).ObjectiveTo 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.DesignProspective cohort study.ParticipantsParticipants were 819 black and white patients with hypertension from an urban, safety-net hospitalMain MeasuresWe 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 ResultsUnadjusted 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).ConclusionsImproved patient-provider communication targeted towards addressing patient concerns about medications may have the potential to reduce racial disparities in TI and ultimately, BP control.

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