Understanding Racial/Ethnic Disparities in Clinician Concordance with Hypertension Treatment Guidelines and Blood Pressure Control - Project Summary/Abstract Despite an equal hypertension treatment rate between Blacks and Whites (79.7% vs. 79.1%), racial/ethnic disparities in blood pressure (BP) control persist with lower rates in Blacks (39.2%), Hispanics (40.0%), Asians (37.8%), compared to Whites (49.1%). Blacks in the Southeastern US were 27% less likely to achieve BP control while they were 69% more likely to receive treatment. Existing studies point towards individual risk factors and lack of healthcare access and insurance as potential causes for these disparities; however, even after accounting for these factors, racial disparities in BP control persist. The reasons for this inequality are yet to be fully understood. Additionally, BP control rates remain low (44%–57%) among treated hypertensives while clinical trials have demonstrated that a high rate of BP control (ranging from 80-90%) can be achieved with currently available therapies by strictly following recommended treatment protocols. This suggests that a higher proportion of uncontrolled BP could be explained by less aggressive treatment, poorer follow-up, and use of fewer or less effective drugs. Despite this, in a national survey, antihypertensive therapy was intensified in only 22-40% of patients with uncontrolled hypertension, and 43% of physicians did not initiate drug therapy unless systolic BP reached ≥160 mmHg. The 2017 Hypertension Treatment Guidelines advocate evidence- based medication selection and titration, however, the role of provider concordance to these guidelines and its impact on racial/ethnic disparity in BP control remains unexplored. Furthermore, conclusions from studies regarding compliance with older hypertension treatment guidelines were compromised due to failure to evaluate multiple aspects of hypertension care, such as comorbidities, follow-up, laboratory assessments, drug side effects, and contraindications. We propose to address these limitations and use an objective and validated measurement of concordance to treatment guidelines. We will utilize data from the Stakeholders, Technology, and Research Clinical Research Network (STAR CRN) – a database of ~14 million racially diverse patients from the Southeastern US, to evaluate: 1) the extent of racial disparity in hypertension treatment based on the AHA/ACC 2017 guidelines in the southeastern US; 2) investigate the patient, physician, clinic, and geo-social factors that predict racial/ethnic disparity in the treatment of hypertension according to recommended guidelines; and 3) ascertain if racial disparity in BP control can be attributed to providers' lack of adherence to treatment guidelines. Moreover, we aim to conduct qualitative interviews with clinicians and patients to gather information on the reasons for providers' deviation from the guidelines and recommendations on improving compliance with the guidelines. Our findings will offer valuable insights into the factors contributing to racial disparities in the treatment of hypertension according to recommended guidelines, and the role of providers' hypertension treatment practices on racial disparity in BP control in the Southeastern US, thereby informing future interventions for promoting BP control and health equity.
