Black Americans have higher rates of hypertension and experience greater difficulty controlling their blood pressure than people of other races. But the fact that health providers are less likely to intensify treatment for Black patients may explain these racial disparities. So suggest new study findings soon to be presented at the American Heart Association’s Scientific Sessions 2020.

Treatment intensification refers to the practice of prescribing a higher dose of a medication a patient is already taking or prescribing a new medication to help lower their blood pressure.

For the study, researchers reviewed the data of more than 15,000 patients treated for hypertension at clinics in San Francisco. Participants represented a diverse range of races, including Asian, Black, Hispanic and white, and were 58 years old on average; 50% of them were women. Patients had uncontrolled blood pressure during at least one clinic visit.

Scientists checked racial differences in participants’ achievement of blood pressure control. In addition, they tried to determine whether those variations could be the result of an increase in medication dosage or missed appointments. 

Results revealed that physicians missed more opportunities to intensify treatment for African-Americans than for people of other races and that African Americans missed more clinic appointments than people of other races. Researchers also noted that lower treatment intensification and missed clinic visits accounted for 28% and 14%, respectively, of the total effect on Black patients’ blood pressure control.

Additionally, the rate of intensified treatment for blood pressure control was lower among African Americans and higher among Asian Americans than among patients of other races.

“We were completely surprised that Asian Americans’ higher performance in achieving normal blood pressure was almost entirely explained by prescribing behavior,” said Valy Fontil, MD, assistant professor of medicine at the University of California San Francisco and first author of the study.

He added that researchers were also surprised that health providers were less likely to intensify treatment for Black patients. 

Fontil suggested that future studies should try to determine why Black patients are less likely to be offered aggressive treatment for their hypertension than Asian Americans.

“These findings also reemphasize the call for adopting treatment protocols and clinical decision supports that can help standardize quality of care for hypertension and perhaps other chronic diseases,” he said.

For related coverage, “High Blood Pressure Common Among Young Black Americans” and "Discrimination Elevates Hypertension Risk for African Americans.”