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Hypertension Treatment and Control in a New York City Health Care System

2022; Wiley; Volume: 11; Issue: 14 Linguagem: Inglês

10.1161/jaha.122.026077

2047-9980

Ayana April-Sanders, Ladan Golestaneh, Lili Zhang, Katrina Swett, Paul Meißner, Carlos J. Rodríguez,

Hormonal Regulation and Hypertension

HomeJournal of the American Heart AssociationVol. 11, No. 14Hypertension Treatment and Control in a New York City Health Care System Open AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citations ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toOpen AccessLetterPDF/EPUBHypertension Treatment and Control in a New York City Health Care System Ayana K. April‐Sanders, PhD, Ladan Golestaneh, MD, MS, Lili Zhang, MD, Katrina Swett, MS, Paul Meissner, MSPH and Carlos J. Rodriguez, MD, MPH Ayana K. April‐SandersAyana K. April‐Sanders https://orcid.org/0000-0003-3341-4464 , Department of Medicine, Cardiology, , Albert Einstein College of Medicine/Montefiore Medical Center, , Bronx, , NY, Search for more papers by this author , Ladan GolestanehLadan Golestaneh , Renal Division, Department of Medicine, , Albert Einstein College of Medicine/Montefiore Medical Center, , Bronx, , NY, Search for more papers by this author , Lili ZhangLili Zhang , Department of Medicine, Cardiology, , Albert Einstein College of Medicine/Montefiore Medical Center, , Bronx, , NY, Search for more papers by this author , Katrina SwettKatrina Swett , Department of Medicine, Cardiology, , Albert Einstein College of Medicine/Montefiore Medical Center, , Bronx, , NY, Search for more papers by this author , Paul MeissnerPaul Meissner https://orcid.org/0000-0003-3424-2481 , Department of Family and Social Medicine, , Albert Einstein College of Medicine/Montefiore Medical Center, , Bronx, , NY, Search for more papers by this author and Carlos J. RodriguezCarlos J. Rodriguez *Correspondence to: Carlos J. Rodriguez, MD, MPH, Albert Einstein College of Medicine, Montefiore‐Einstein Center for Heart & Vascular Care, 1300 Morris Park Avenue, Block Building, Room 217, Bronx, NY 10461. Email: E-mail Address: [email protected] https://orcid.org/0000-0003-0860-9008 , Department of Medicine, Cardiology, , Albert Einstein College of Medicine/Montefiore Medical Center, , Bronx, , NY, Search for more papers by this author Originally published15 Jul 2022https://doi.org/10.1161/JAHA.122.026077Journal of the American Heart Association. 2022;11:e026077Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: July 15, 2022: Ahead of Print Hypertension contributes to socioeconomic and racial and ethnic disparities in potential life‐years lost.1 The prevalence and incidence of hypertension are higher among non‐Hispanic (NH) Black versus NH White adults.1 Hypertension control among those treated for hypertension has been persistently lower for NH Black than for NH White adults of all ages.2 Recent evidence suggests hypertension control is also lower in Hispanic and Asian populations than among NH White populations,3 but the evidence in this area is limited.4 Assessing the racial and ethnic disparities in hypertension prevalence and control in “real world” clinical care settings can be valuable for bridging knowledge gaps and improving health care outcomes. We investigated the prevalence and patient characteristics correlated with hypertension control in the Montefiore Health System, a health system serving predominantly minoritized groups that has an extensive ambulatory care network with 2.8 million visits annually with locations in the Bronx and throughout New York City and the Southern portion of Upstate New York.The data that support the findings of this study are available from the corresponding author upon reasonable request. Using outpatient care data, we included all individuals with hypertension defined by International Classification of Diseases, Ninth and Tenth Revisions (ICD‐9 and ICD‐10) codes during 2018. Prescribed antihypertensive medications determined treatment status (treated versus untreated), which was assessed among all patients with hypertension. Hypertension control status, based on average measured blood pressure (BP): Joint National Commission criteria (<140/90 mm Hg); or American Heart Association/American College of Cardiology criteria ( 60 years (61%), more likely to be NH Black or Hispanic (60%) and reported ≥1 comorbidities (76%) (all P<0.0001). Among those treated, the prevalence of BP control by Joint National Commission criteria was lowest for NH Black (53%, P<0.0001) and Hispanic (58%, P<0.0001) patients than for NH White and Asian patients (64%, each), and highest in patients ≥60 years (63%, P<0.0001) and those with comorbidities (89%, P=0.002) (Figure). Sociodemographic and clinical factors correlating with controlled BP compared with uncontrolled BP among treated patients included higher mean SES index scores (−3.0±2.9 versus −3.2±2.9), lower mean low‐density lipoprotein cholesterol (96.3±36.4 versus 101.9±37.8), lower creatinine levels (1.0±0.8 versus 1.16±1.1), older age (≥60 versus <60 years), and greater likelihood of never smoking (58.0% versus 49.5%); all P<0.01. Similar discrepancies were apparent at the 130/80 mm Hg threshold. BP treatment and control prevalence was similar in NH Asian and White patients, and BP control characteristics did not vary by sex.Download figureDownload PowerPointFigure 1. Distribution of patient characteristics by hypertension treatment status (A) and percent controlled and uncontrolled hypertension by criteria and racial and ethnic group (B).NH indicates non‐Hispanic.Significant racial and ethnic disparities exist in the prevalence and control of hypertension. Compared with 2015 to 2018 National Health and Nutrition Examination Survey data, our hypertension treatment and control estimates by Joint National Commission criteria were lower than national estimates.2 NH White and NH Asian patients with hypertension had better BP control despite lower treatment rates than NH Black and Hispanic patients who had poorer BP control with higher treatment. Differences in the social contexts of our patient population compared with nationally representative samples may explain the divergence between these regional/local estimates and national trends in hypertension treatment and control. The Bronx, where most patients reside, is a unique urban setting characterized by low social resources and income and predominantly Black and Caribbean‐Hispanic communities at high‐risk for hypertension. Greater social deprivation significantly contributes to poor hypertension control even when hypertension screening and treatment resources are available.4 Compared with the predominant composition of Hispanic adults of Mexican descent in National Health and Nutrition Examination Survey, our study adds information about the high prevalence of hypertension and the low rates of treatment and BP control within a predominantly Caribbean‐Hispanic population in Bronx, NY at higher risk for hypertension. A limitation of our study is the absence of time elapsed between patients' hypertension diagnosis and follow‐up care within the Montefiore Health System. We also lacked information on hypertension prescriptions from providers outside the Montefiore Health System network.The gap between the availability of adequate medical treatment and the realization of improvement in health outcomes can be attributed to causes that fall outside the scope of traditional medical care. Improving hypertension control and reducing disparities require equitable access to high‐quality health care, improving patient adherence, and addressing the barriers of social determinants of health and structural racism to achieve healthier lifestyles. Our findings highlight that although it appears we have made strides with hypertension treatment, therapeutic inertia, along with other factors, remain obstacles to addressing inequities in BP control effectively. Our findings are consistent with the data from National Health and Nutrition Examination Survey, where Black adults with hypertension are more likely to be treated but still less likely to be controlled than NH White adults.3 Developing approaches to address these findings is particularly important in marginalized, low‐income communities at higher risk of hypertension‐related morbidity and mortality.Sources of FundingAyana K. April‐Sanders, PhD received support from the National Institutes of Health (5T32HL144456‐03). Carlos J. Rodriguez, MD, MPH is supported by grants from the National Institutes of Health (R01 HL04199, 75N92019D00011, 1U01HL146204‐01, 5R01HL144707) and the American Heart Association (5P50HL120163‐04). Lili Zhang, MD received grant support from the Glorney‐Raisbeck Junior Faculty Research Award in Cardiovascular Diseases.DisclosuresCarlos J. Rodriguez, MD, MPH has served as a consultant for Merck and reports grant support from Amgen, Inc. Ladan Golestaneh, MD serves on the clinical events committee of the Medtronic sponsored Renal Sympathetic Denervation in Patients With Treatment‐Resistant Hypertension (SYMPLICITY HTN) and Symplicity Spyral Multi‐Electrode Renal Denervation System in Patients With Uncontrolled Hypertension Off Standard Medication Therapy (SPYRAL HTN‐OFF) trials. The remaining authors have no disclosures to report.Footnotes*Correspondence to: Carlos J. Rodriguez, MD, MPH, Albert Einstein College of Medicine, Montefiore‐Einstein Center for Heart & Vascular Care, 1300 Morris Park Avenue, Block Building, Room 217, Bronx, NY 10461. Email: carlos.[email protected]eduFor Sources of Funding and Disclosures, see page 3.References1 Wong MD, Shapiro MF, Boscardin WJ, Ettner SL. Contribution of major diseases to disparities in mortality. N Engl J Med. 2002; 347:1585–1592. doi: 10.1056/NEJMsa012979CrossrefMedlineGoogle Scholar2 Egan BM, Li J, Sutherland SE, Rakotz MK, Wozniak GD. Hypertension control in the United States 2009 to 2018: factors underlying falling control rates during 2015 to 2018 across age‐ and race‐ethnicity groups. Hypertension. 2021; 78:578–587. doi: 10.1161/HYPERTENSIONAHA.120.16418LinkGoogle Scholar3 Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, et al. Heart disease and stroke Statistics‐2019 update: a report from the American Heart Association. Circulation. 2019; 139:e56–e528. doi: 10.1161/CIR.0000000000000659LinkGoogle Scholar4 Braveman P, Gottlieb L. The social determinants of health: it's time to consider the causes of the causes. Public Health Rep. 2014; 129(suppl 2):19–31. doi: 10.1177/00333549141291S206CrossrefMedlineGoogle Scholar5 Roux AVD, Merkin SS, Arnett D, Chambless L, Massing M, Nieto FJ, Sorlie P, Szklo M, Tyroler HA, Watson RL. Neighborhood of residence and incidence of coronary heart disease. N Engl J Med. 2001; 345:99–106. doi: 10.1056/nejm200107123450205CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails July 19, 2022Vol 11, Issue 14Article InformationMetrics Copyright © 2022 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley BlackwellThis is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.https://doi.org/10.1161/JAHA.122.026077PMID: 35861846 Manuscript receivedMarch 25, 2022Manuscript acceptedJune 13, 2022Originally publishedJuly 15, 2022 Keywordstreatmenturban settingcontroldisparitieshypertensionPDF download SubjectsEpidemiologyHigh Blood PressureHypertensionRace and Ethnicity