Racial Inequities in Hypertension Treatment Intensification

doctor and patient blood pressure measure
doctor checking elderly man’s blood pressure, african american, black
Racial inequities in treatment intensification may be responsible for more than 20% of racial disparities in hypertension control.

This article is part of Cardiology Advisor‘s coverage of AHA Scientific Sessions 2020.

Racial inequities in treatment intensification may be responsible for more than 20% of racial disparities in hypertension control, according to study results presented at the American Heart Association (AHA) Scientific Sessions 2020, held virtually from November 13 to 17, 2020.1

Investigators used a structural equation multivariate regression model to estimate the likelihood of blood pressure (BP) control (ie, BP <140/90 mm Hg) in Black and White patients with hypertension, as a factor of treatment intensification and missed visits. A total of 6556 patients (mean age, 57.0±11.2 years; 41% women; 44% Black) who were diagnosed with hypertension and who had ≥1 clinic visit with uncontrolled BP (ie, BP ≥140/90 mm Hg).  

Missed visits were defined as “no-shows” in the 4 weeks following a recording of uncontrolled BP. BP control was defined according to the most recent BP measure (as of November 15, 2017). The model was adjusted for gender, age, first recorded BP level between January 2015 and November 2017, visit frequency, and a diagnosis of diabetes.  

Black vs White patients had more missed opportunities for treatment intensification (β = -0.02; P <.001) and more missed visits (β = 0.37; P <.001). After accounting for differences in missed opportunities and visits, Black patients remained less likely than white patients to achieve BP control (β = 0.16; odds ratio, 0.85; 95% CI, 0.76-0.95). The indirect effect of decreased treatment intensification and missed visits accounted for 22% and 13%, respectively, of the total effect of black race on BP control.  

“Although other investigators have shown that treatment decisions for some conditions such as pain can vary based on the patient’s race and physician bias, this phenomenon has not been widely reported for hypertension treatment,” noted lead author, Valy Fontil, MD, MAS, assistant professor of medicine at the University of California, San Francisco.2 “These findings also re-emphasize the call for adopting treatment protocols and clinical decision supports that can help standardize quality of care for hypertension and perhaps other chronic diseases.”


  1. Fontil V, Pacca L, Bellows B, et al. Impact of racial differences in treatment intensification and missed visits on disparities in BP control. Presented at: AHA Scientific Sessions 2020; November 13-17, 2020. Presentation MP269.
  2. Black patients less likely to receive added, higher dose meds to control blood pressure [press release]. Dallas, Texas: American Heart Association; November 9, 2020.

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