Key result
Black patients linked to ~3 percentage points lower hypertension treatment intensification versus White patients.
Why the study?
To demonstrate the application of the Target Study conceptual model to measure racial and ethnic disparities in hypertension treatment intensification consistent with the Institute of Medicine definition.
Does accounting for allowable clinical covariates via the Target Study conceptual model reveal racial disparities in antihypertensive treatment intensification between Black and White adults with uncontrolled hypertension?
Cohort (n=25,287)
Yes
Does accounting for allowable clinical covariates via the Target Study conceptual model reveal racial disparities in antihypertensive treatment intensification between Black and White adults with uncontrolled hypertension?
Applying the IOM-concordant Target Study framework reveals that although Black patients have higher crude rates of hypertension treatment intensification due to greater clinical need, they are 3 to 4 percentage points less likely than White patients with comparable clinical need to have their therapy intensified.
Answers are grounded in this paper and cite their sources.
Adjusted disparities indicate lower intensification for Black patients; hypothesis-generating for non-clinical factors and equitable care interventions.
Background: This tutorial paper demonstrates the application of a conceptual model to measure racial and ethnic disparities in treatment intensification among adults with hypertension consistent with the Institute of Medicine (IOM) definition. The IOM defines disparity as differences in health care quality that are not due to access-related factors, clinical needs, preferences, and appropriateness of intervention (referred to as allowable covariates). Methods: We used a conceptual model called the Target Study to estimate annual disparities in the probability of treatment intensification between Black and White patients seen at primary care clinics within a large healthcare system in the Mid-Atlantic region from 2018 to 2022, using electronic medical record data. We emulated the specified target study through an appropriate study design and the use of inverse probability weighting to balance allowable covariates while measuring disparities. Results: Unadjusted analyses showed a higher percentage of treatment intensification for Black patients compared with White patients, with annual differences ranging from 2 to 4 percentage points. For example, in 2020, the unadjusted difference was three percentage points (95% confidence interval: 1%, 5%). After adjusting for allowable covariates via the emulated target study, Black patients had consistently lower percentages of treatment intensification by 3–4 percentage points each year. For example, in 2020, the adjusted disparity was −3 percentage points (95% confidence interval: −4%, −1%). Conclusions: The Target Study can implement the IOM definition for measuring disparities in health care. Future research should explore its application across different populations to better understand and address health disparities.
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Meche et al. (2026) conducted a cohort in Hypertension with elevated blood pressure (≥140/90 mm Hg) (n=25,287). Non-Hispanic Black race (evaluated using the Target Study conceptual model with inverse probability weighting) vs. Non-Hispanic White race (reweighted to match the Black population's allowable covariate distribution) was evaluated on Treatment intensification (addition of an antihypertensive medication class or an increase in dosage within 14 days of an index visit with elevated BP ≥140/90 mm Hg) (Adjusted difference -3 percentage points (in 2020; -3 to -4 percentage points annually), 95% CI -4% to -1%). Non-Hispanic Black patients had a 3 to 4 percentage point lower annual probability of hypertension treatment intensification than White patients after adjusting for allowable clinical covariates.
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