BACKGROUND/RATIONALE:
Hypertension is the most common chronic condition among Veterans, affecting 37% of patients. Hypertension can lead to stroke, myocardial infarction, chronic kidney disease, and heart failure. Among US blacks, hypertension tends to occur earlier in life, is more common and severe, and is less likely to be controlled compared to whites. Blood pressure control has significantly improved among Veterans, from 46% in 2000 to 76% in 2010, however disparities in blood pressure control persist and reasons for the disparities are not well understood. Recently, the Systolic Blood Pressure Intervention Trial (SPRINT), led to changes in hypertension management guidelines. SPRINT investigators reported that reducing systolic blood pressure to <120 mmHg (versus <140 mmHg) lowered risk of cardiovascular events and mortality in 3 years of follow-up. The extent to which systolic blood pressure control of <120 mmHg is achieved overall and by race/ethnicity in the Veteran's Health Administration is unknown.

OBJECTIVE(S):
To identify patient-level (Aim 1), provider- and facility-level (Aim 2) predictors of use of guideline-recommended medications and blood pressure control among Veterans with newly diagnosed hypertension and to describe how the effect of these predictors vary by race; to develop and pilot test a provider/team focused informatics strategy to facilitate hypertension control tailored to reduce minority race disparities (Aim 3).

METHODS:
Aim 1: We are conducting a national longitudinal cohort study of Veterans who accessed primary care within the Veterans Health Administration (VHA) and who received a new hypertension diagnosis between 2007 and 2012. Our study includes 21,125 black and 162,800 white Veterans with a new hypertension diagnosis over the 5-year period. We are assessing patient predictors (e.g. demographic, clinical, military characteristics) for achieving blood pressure control at 1-year follow-up by race using regression analyses. Aim 2: Among the Veterans included in Aim 1, we are using quantitative analysis methods similar to Aim 1 to identify provider- (e.g. number of visits with provider) and facility (e.g. urban/rural)-level predictors. We are also reviewing 300 charts and conducting semi-structured interviews with 36 Patient Aligned Care Team (PACT) providers to identify reasons for lack of guideline-concordant blood pressure management/prescribing. Aim 3: Aims 1-2 will inform the clinical decision support strategy which will align with current blood pressure management guidelines and will be developed to support the PACT workflow.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
In 2014 11% of Veterans were black and this group is expected to grow by at least 3% over the next 20 years. My research aims to identify the causes of blood pressure related disparities and ultimately to develop an informatics strategy to support high quality, equitable healthcare for all Veterans. This research is consistent with the VA Blueprint for Excellence Transformational Actions: "to understand and eliminate health inequalities" and the VHA's Strategic Objective on Quality & Equity to ensure that Veterans receive "timely, high quality, personalized, safe effective and equitable health care."

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External Links for this Project

NIH Reporter

Grant Number: IK2HX002609-02
Link: https://reporter.nih.gov/project-details/9415994

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PUBLICATIONS:

Journal Articles

1. Derington CG, Cohen JB, Mohanty AF, Greene TH, Cook J, Ying J, Wei G, Herrick JS, Stevens VW, Jones BE, Wang L, Zheutlin AR, South AM, Hanff TC, Smith SM, Cooper-DeHoff RM, King JB, Alexander GC, Berlowitz DR, Ahmad FS, Penrod MJ, Hess R, Conroy MB, Fang JC, Rubin MA, Beddhu S, Cheung AK, Xian W, Weintraub WS, Bress AP. Angiotensin II receptor blocker or angiotensin-converting enzyme inhibitor use and COVID-19-related outcomes among US Veterans. PLoS ONE. 2021 Apr 23; 16(4):e0248080. [view]
2. Mohanty AF, Levitan EB, Dodson JA, Vardeny O, King JB, LaFleur J, He T, Patterson OV, Alba PR, Russo PA, Choi ME, Bress AP. Characteristics and Healthcare Utilization Among Veterans Treated for Heart Failure With Reduced Ejection Fraction Who Switched to Sacubitril/Valsartan. Circulation. Heart failure. 2019 Nov 1; 12(11):e005691. [view]
3. Mohanty AF, McAndrew LM, Helmer D, Samore MH, Gundlapalli AV. Chronic Multisymptom Illness Among Iraq/Afghanistan-Deployed US Veterans and Their Healthcare Utilization Within the Veterans Health Administration. Journal of general internal medicine. 2018 Sep 1; 33(9):1419-1422. [view]
4. Bress AP, Cohen JB, Anstey DE, Conroy MB, Ferdinand KC, Fontil V, Margolis KL, Muntner P, Millar MM, Okuyemi KS, Rakotz MK, Reynolds K, Safford MM, Shimbo D, Stuligross J, Green BB, Mohanty AF. Inequities in Hypertension Control in the United States Exposed and Exacerbated by COVID-19 and the Role of Home Blood Pressure and Virtual Health Care During and After the COVID-19 Pandemic. Journal of the American Heart Association. 2021 Jun 1; 10(11):e020997. [view]
5. Mohanty AF, Levitan EB, King JB, Dodson JA, Vardeny O, Cook J, Herrick JS, He T, Patterson OV, Alba PR, Russo PA, Obi EN, Choi ME, Fang JC, Bress AP. Sacubitril/Valsartan Initiation Among Veterans Who Are Renin-Angiotensin-Aldosterone System Inhibitor Naïve With Heart Failure and Reduced Ejection Fraction. Journal of the American Heart Association. 2021 Oct 19; 10(20):e020474. [view]

DRA: Health Systems, Cardiovascular Disease
DRE: Prognosis, TRL - Applied/Translational
Keywords: none
MeSH Terms: none