Racial Disparities in Blood Pressure Control and Treatment Differences in a Medicaid Population, North Carolina, 2005-2006 | Preventing Chronic Disease: May 2011: 10_0070

ORIGINAL RESEARCH
Racial Disparities in Blood Pressure Control and Treatment Differences in a Medicaid Population, North Carolina, 2005-2006

Diane L. Downie, MPH; Dorothee Schmid, MA; Marcus G. Plescia, MD, MPH; Sara L. Huston, PhD; Susan Bostrom, RN; Angie Yow, RN; William W. Lawrence Jr., MD; C. Annette DuBard, MD, MPH

Suggested citation for this article: Downie DL, Schmid D, Plescia MG, Huston SL, Bostrom S, Yow A, et al. Racial disparities in blood pressure control and treatment differences in a Medicaid population, North Carolina, 2005-2006. Prev Chronic Dis 2011;8(3). http://www.cdc.gov/pcd/issues/may/10_0070.htm. Accessed [date].

PEER REVIEWED

Abstract
Introduction
Racial disparities in prevalence and control of high blood pressure are well-documented. We studied blood pressure control and interventions received during the course of a year in a sample of black and white Medicaid recipients with high blood pressure and examined patient, provider, and treatment characteristics as potential explanatory factors for racial disparities in blood pressure control.

Methods
We retrospectively reviewed the charts of 2,078 black and 1,436 white North Carolina Medicaid recipients who had high blood pressure managed in primary care practices from July 2005 through June 2006. Documented provider responses to high blood pressure during office visits during the prior year were reviewed.

Results
Blacks were less likely than whites to have blood pressure at goal (43.6% compared with 50.9%, P = .001). Blacks above goal were more likely than whites above goal to have been prescribed 4 or more antihypertensive drug classes (24.7% compared with 13.4%, P < .001); to have had medication adjusted during the prior year (46.7% compared with 40.4%, P = .02); and to have a documented provider response to high blood pressure during office visits (35.7% compared with 30.0% of visits, P = .02). Many blacks (28.0%) and whites (34.3%) with blood pressure above goal had fewer than 2 antihypertensive drug classes prescribed. Conclusion In this population with Medicaid coverage and access to primary care, blacks were less likely than whites to have their blood pressure controlled. Blacks received more frequent intervention and had greater use of combination antihypertensive therapy. Care patterns observed in the usual management of high blood pressure were not sufficient to achieve treatment goals or eliminate disparities. full-text: Preventing Chronic Disease: May 2011: 10_0070



Author Information
Corresponding Author: Diane Downie, MPH, Public Health Preparedness Program, Division of Public Health, 1 West Wilson St, Rm 250, PO Box 2659, Madison, WI 53703. Telephone: 608-267-2887. E-mail: diane.downie@wi.gov. Ms Downie was affiliated with the North Carolina Department of Health when the research for this article was conducted.

Author Affiliations: Dorothee Schmid, Marcus G. Plescia, Sara L. Huston, Susan Bostrom, Angie Yow, William W. Lawrence, Jr, C. Annette DuBard, North Carolina Department of Health and Human Services, Raleigh, North Carolina. Dr Huston and Dr DuBard are also affiliated with the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.