The Medical clinics of North America
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Med. Clin. North Am. · Sep 2005
ReviewUpdate on disparities in the pathophysiology and management of hypertension: focus on African Americans.
Hypertension treatment and control is of paramount importance in the prevention of premature cardiovascular disease. African Americans present a special challenge to the clinician due, in part, to their earlier age of onset,greater prevalence, and increased rates of untoward events. A review of the recent studies of genetic epidemiology has not revealed unique genotypes that explain human hypertension or the disparate impact suffered by African Americans. ⋯ These findings suggest that to have an immediate and substantial impact on the ethnic disparity of hypertension, resources and research should be directed toward social and behavioral factors. Prompt and aggressive control of blood pressure is an effective global strategy for cardiovascular risk reduction. In most cases, this approach requires multiple interventions including lifestyle modification and an antihypertensive regimen that is tailored to the individual under the current guidelines and not stipulated by race.
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Med. Clin. North Am. · Sep 2005
ReviewIssues in minority health: atherosclerosis and coronary heart disease in African Americans.
Cardiovascular disease (in particular, CHD) is the leading cause of death in the United States for Americans of both sexes and of all racial and ethnic backgrounds. African Americans have the highest overall CHD mortality rate and the highest out-of-hospital coronary death rate of any ethnic group in the United States, particularly at younger ages. Contributors to the earlier onset of CHD and excess CHD deaths among African Americans include a high prevalence of coronary risk factors, patient delays in seeking medical care, and disparities in health care. ⋯ African Americans who have ACSs receive less aggressive treatment than their white counterparts but they should not. Use of evidence-based therapies for management of patients who have ACSs and better understanding of various available treatment strategies are of utmost importance. Reducing and ultimately eliminating disparities in cardiovascular care and outcomes require comprehensive programs of education and advocacy(Box 4) with the goals of (1) increasing provider and public awareness of the disparities in treatment; (2) decreasing patient delays in seeking medical care for acute myocardial infarction and other cardiac disorders; (3) more timely and appropriate therapy for ACSs; (4) improved access to preventive, diagnostic, and interventional cardiovascular therapies; (5) more effective implementation of evidence-based treatment guidelines; and (6) improved physician-patient communications.
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African Americans and other ethnic minority groups suffer disproportionately from type 2 diabetes and its complications than do white Americans. Genetic and environmental factors contribute to the ethnic disparities in diabetes and its complications. ⋯ The progressive nature of diabetes requires the use of more than one agent. Drug combinations should be selected for their therapeutic fire power and complementary mechanisms of action, and exogenous insulin need not be delayed unnecessarily if oral agents are ineffective.
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Socioeconomic factors and differences in access to health care systems, perhaps more so than physiologic differences, play a significant role in race-based differences faced by acute care practitioners.
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Med. Clin. North Am. · Sep 2005
ReviewIs there disparity in the care of minority patients with upper aerodigestive tract malignancy?
The data presently available indicate that there is unequal (disparate) care in patients with head and neck cancer. The reasons for this are likely multifactorial and require further study. ⋯ For example, Hispanics are not a homogeneous ethnic group; hence, differences in social perception, cultural mores, and available medical resources can be demonstrated that can directly impact care and outcome. Appropriate epidemiologic studies are needed with more underserved minority patients to analyze these differences further and to address such differences.