46 Investigating Differences in Black vs Other Race/Ethnic Group Veterans When Attaining Controlled Blood Pressure Post Treatment

Faculty Mentor: April Mohanty (Internal Medicine, University of Utah)

Abstract

Hypertension is one of the primary risk factors contributing to cardiovascular diseases (CVD), including related premature morbidity and mortality. Risk factors for hypertension include lifestyle factors such as, high sodium diets, tobacco exposure, as well as genetics, and older age. The Veterans Health Administration (VHA) recently updated its hypertension diagnosis guidelines in 2017 which aligns with many of the updated recommendations of the American College of Cardiology/American Heart Association. Hypertension in the VHA is now diagnosed at 130 mmHg systolic and 90 mmHg diastolic blood pressure. Diagnosing hypertension at a lower threshold not only increases the number of individuals with hypertension but, more importantly, helps to promote earlier initiation of antihypertensive treatment, delaying CVD. This study aims to identify clinically meaningful differences in the initial treatment and management of blood pressure in Blacks and Veterans of other race/ethnicities achieving controlled blood pressure after initial treatment. Identifying racial disparity gaps is essential to treating and managing hypertension to prevent related comorbidities. To accomplish this, we will conduct a retrospective cohort study, to evaluate blood pressure control one year following treatment initiation. The study will be conducted with nationwide data already collected by the VHA’s electronic health record system. Participants in this study will include individuals over 18 years old, seeking care at the VHA, and having a hypertension diagnosis. We will identify if there is a clinically meaningful difference in blood pressure control post-treatment initiation across race/ethnic groups. Our results show a blood pressure control prevalence range of 27.1% to 31.5% across different race/ethnic groups. Our analysis also detected a 4.4% difference in blood pressure control prevalence between NH-Black and NH-White Veterans. Our primary findings conclude that no clinically meaningful difference exists between controlled blood pressure in Black vs. other race/ethnic group Veterans. Our findings show that improving equity in blood pressure control according to the current guidelines by race/ethnicity is needed to prevent disparities of more severe CVD outcomes later in life (1). Strengths of the study include a large national patient sample and data on variables with validated definitions. The limitations presented in our study were limited generalizability due to the underrepresentation for example female gender presented in the study. Future directions for this study include longer follow-up periods for outcomes and include individuals who are not new initiators of hypertension medications.

References

1. Whelton PK, Carey RM, Aronow WS, Casey DE, Jr., Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, et al. 2017

ACC/AHA/AAPA/ABC/ACPM/AGS/APHA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71:e127-e248