Better care means better blood pressure control

It's well known that there are racial differences in how well high blood pressure is controlled, but this may be not so much an ethnic issue as one of access to good medical care, a study suggests.

Specifically, the study shows that blood pressure control among hypertensive African American men is better for those cared for in the Veterans Affairs (VA) health system - which provides access to healthcare and medications across ethnic, racial and economic boundaries - compared with those cared for outside the VA system.

"There is huge disparity in blood pressure control rates in different races, particularly in men," said Dr. Shakaib U. Rehman from the Ralph H. Johnson VA Medical Center in Charleston, South Carolina.

"Disparities in cardiovascular risk factor control and outcomes are striking for African American men," he said.

Rehman and his colleagues compared the treatment and control of hypertension in African American and white men treated at VA or non-VA facilities. The VA population included 4379 African American and 7987 white men, whereas the non-VA population included 2754 African American and 4980 white men.
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In VA and non-VA groups, whites were older than African Americans, had lower blood pressure, and had blood pressure controlled to below the goal of 140/90 more often, the investigators report in the Archives of Internal Medicine.

They also report that blood pressure control rates were comparable in white men in both healthcare systems - about 55 percent of patients achieved the target blood pressure.

In contrast, blood pressure control rates in African American men were better at the VA sites (49 percent) than the non-VA sites (44 percent), although they still were not as good as control rates among white men.

In this study, "the ethnic disparity in blood pressure control between African Americans and whites was approximately 40 percent less at VA than at non-VA healthcare sites," Rehman noted.

"The major implication of this study is that access to care may be very important to improve the blood pressure control rates, since the VA system provides access to care and medication," Rehman said.

"I personally think that the VA is doing a great job providing state-of-the-art medical care to our nations' veterans," he added.

SOURCE: Archives of Internal Medicine, May 9, 2005.