Abstract
Background: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII) recommends lifestyle modifications (such as reducing sodium intake) to help control blood pressure (BP) in adults with hypertension. We analyzed variation by race in self-reported actions to control BP, both lifestyle activities and receipt of physician advice, within a random sample of adults with hypertension in a group-model managed care organization.
Methods: We randomly sampled 3000 18- to 74-year-olds with hypertension (750 from each of the 4 JNC VII hypertension stages) who had BP measured on at least 2 recent primary care visits. The survey, administered by telephone in 2007, included the Behavioral Risk Factor Surveillance System (BRFSS) Actions to Control Blood Pressure items and questions on race/ethnicity and socioeconomic status. Data on enrollee demographics, body mass index, antihypertensive medication use, and preexisting diabetes, hyperlipidemia, coronary artery disease and congestive heart failure were obtained from computerized administrative data. Lifestyle activities and receipt of physician advice were analyzed between black and white patients using descriptive and multivariate logistic regression analyses, adjusting for age and gender, BP control, obesity and pre-existing chronic conditions.
Results: Seven hundred thirty-nine adults responded (25% overall response rate, 58% cooperation rate – similar to the 2006 national BRFSS rates). Blacks (54% of respondents) were older, had worse BP control, and had higher prevalence of obesity and diabetes than whites (all P=<0.05). Blacks were more likely than whites to report changing dietary habits to control BP (88% vs. 82%, P=0.02) and to report receipt of advice on dietary habits, salt reduction, alcohol consumption, and exercise (all P=<0.01). The higher likelihood of blacks reporting receipt of advice remained significant (OR=1.6 on alcohol consumption to OR=2.5 on salt reduction, all P=<0.01) in multivariate models.
Conclusions: In this sample of adults with hypertension, blacks were more likely than whites to report receipt of advice from physicians on actions to control BP. Although blacks had worse BP control and a higher prevalence of obesity, which had independent associations with receipt of advice, these factors did not account for the racial disparities. Further research is needed to clarify whether the racial differences in self-reported receipt of advice represent a recall or response bias, or other unmeasured patient or delivery system factors that affect likelihood of a patient receiving advice on actions to control BP.
- Received September 11, 2008.
