In patients with uncontrolled hypertension and an established primary care relationship, baseline blood pressure values were similar across racial and socioeconomic groups, suggesting disparities may be less prevalent in this setting.
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Established primary care relationships may attenuate racial/socioeconomic BP disparities; extends prior observational data to RCT cohorts.
This paper examines baseline characteristics from a prospective, cluster-randomized trial in 32 primary care offices. Offices were first stratified by percentage of minorities and level of clinical pharmacy services and then randomized into 1 of 3 study groups. The only differences between randomized arms were for marital status (P=.03) and type of insurance coverage (P<.001). Blood pressures (BPs) were similar in Caucasians and minority patients, primarily blacks, who were hypertensive at baseline. On multivariate analyses, patients who were 65 years and older had higher systolic BP (152.4 ± 14.3 mm Hg), but lower diastolic BP (77.3 ± 11.8 mm Hg) compared with those younger than 65 years (147.4 ± 15.0/88.6 ± 10.6 mm Hg, P<.001 for both systolic and diastolic BP). Other factors significantly associated with higher systolic BP were a longer duration of hypertension (P=.04) and lower basal metabolic index (P=.011). Patients with diabetes or chronic kidney disease had a lower systolic BP than those without these conditions (P<.0001). BP was similar across racial and socioeconomic groups for patients with uncontrolled hypertension in primary care, suggesting that patients with uncontrolled hypertension and an established primary care relationship likely have different reasons for poor BP control than other patient populations.
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Carter et al. (2013) studied this question.
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