Study Suggests Significant Racial and Ethnic Differences in Blood Pressure Control among Veterans with Type 2 Diabetes
Many patients with diabetes have comorbid cardiovascular risk factors including hypertension, and current guidelines emphasize the importance of risk factor control in diabetic patients. Despite increases in the prevalence of hypertension, the U.S. has seen marked improvements in hypertension awareness, treatment, and control; however, racial and ethnic disparities in these factors persist in the general population. This retrospective cohort study examined racial/ethnic differences in blood pressure control among Veterans with type 2 diabetes from 1996 through 2006 (mean follow-up was 5 years) and uncontrolled BP at baseline. Using VA data, investigators identified 5,319 Veterans with type 2 diabetes and initially uncontrolled BP (>140/>90mmHg) in the first year they participated in the study, who had received treatment at one VA facility in the Southeastern U.S. Each Veteran’s mean blood pressure was assessed every year, with BP control defined as <140/<90 mmHg. The main predictor variable was race/ethnicity, categorized as: non-Hispanic White (46%), non-Hispanic Black (26%), Hispanic/Other (19%), and Unknown (9%). Investigators also examined socio-demographics, service-connectedness, and medical and psychiatric comorbidities.
- The adjusted proportion of Veterans with uncontrolled BP (>=140/90 mmHg) decreased in all groups over the study period. However, ethnic minority Veterans had significantly increased odds of poor BP control over a mean follow-up of 5 years compared to non-Hispanic White Veterans, independent of socio-demographic factors and comorbidity patterns. Compared to non-Hispanic Whites (45%), 54% of non-Hispanic Black Veterans, 48% of Hispanic Veterans, and 49% of Veterans with unknown race had poor blood pressure control.
- In using a more stringent BP cutoff (>=130/80 mmHg) to define poor BP control, 74% of non-Hispanic White Veterans had poor blood pressure control over the 5 years compared to 82% of non-Hispanic Black Veterans, 75% of Hispanic Veterans, and 79% of Veterans with unknown race/ethnicity.
- The presence of a hypertension diagnosis at the time of study entry appears to be associated with higher odds of achieving BP control over time. Among other comorbidities, cancer, coronary heart disease, congestive heart failure, and substance use disorders were all associated with increased odds of good BP control over time.
- It is possible that unmeasured factors may have confounded the relationship between race/ethnicity and BP control.
- Data on medication usage and adherence, health literacy, disease beliefs, and trust in healthcare providers were not available for this study.
This study was funded by HSR&D. All authors are part of HSR&D’s Center for Disease Prevention and Health Interventions for Diverse Populations, Charleston, SC.
Axon R, Gebregziabher M, Echols C, Gilbert G, and Egede L. Racial and Ethnic Differences in Longitudinal Blood Pressure Control in Veterans with Type 2 Diabetes Mellitus. Journal of General Internal Medicine June 14, 2011;Epub ahead of print.