Racial and Ethnic Disparities in Blood Pressure Treatment for African Americans

by Erica Thorpe, MHA Graduate Student

Published February 21, 2022

Image of an African American looking at blood pressure medications

Here at Firefly, we have worked hard to build a care model that supports increased access to health services for ALL communities and we are constantly leveraging data to promote more equitable and inclusive systems of care (click here to read more about a recent AWS award we received to help us in our quest to advance health equity). In honor of both American Heart Month and Black History Month, our care team would like to shine a light on the unfortunate discrimination African Americans face in healthcare, specifically on the topic of high blood pressure, and how we are working to fix it!

African Americans face significant inequalities and discrimination, which negatively impacts their health outcomes. Studies find that African Americans have a higher risk of hypertension due to discrimination, increased aggravations in treatment, and differences in follow-up intervals. They have the highest risk of hypertension compared to other racial and ethnic minority groups. Hypertension is the primary cause of serious health complications such as a heart attack, stroke, kidney disease, aneurysm, and other fatal health conditions. These conditions can be prevented with good blood pressure (BP) control.

Hypertension can form through unhealthy lifestyle decisions such as poor dietary habits, lack of exercise, unhealthy alcohol use, and other factors that serve as coping methods for stress. Discrimination is known as a chronic life stressor that can lead to numerous unhealthy behaviors. Discrimination affects the nervous system via the stress pathway, activating the sympathetic nervous system, which causes involuntary responses to stressful or harmful situations.

Lifetime and daily discriminations faced by African Americans cause chronic stress, which can lead to hypertension and other diseases. A study conducted by the Jackson Heart Study found that lifetime discrimination caused 52% of African American participants to develop hypertension. There are numerous factors associated with higher prevalence of hypertension (e.g. smoking, poor physical activity, and nutrition), but they do not answer why racial differences exist.

Blood Pressure control with hypertension lowest among African Americans patients

Black and White individuals are equally aware of the harms of hypertension, however Blacks are much less probable to receive quality treatment for blood pressure control.

There are several factors that contribute to these disparities. A 2021 study examined if treatment intensification, follow-up intervals, and missed appointments were associated with disparities in BP control from 2015 to 2017. The patients in the study were Black, White, Asian, and Hispanic. In comparison to other races, Black patients had the lowest level (66.1%) of BP control at their last visit. Overall, Black patients attended more follow-up visits for BP control than other patients. However, Black patients had the greatest missed appointments and lowest treatment intensification levels compared to Asian patients who had the least missed appointments and highest treatment levels.

Low visit attendance for Black patients is associated with poor insurance coverage, substandard economic stability, lack of transportation, and low health literacy levels. Healthcare organizations must implement a team-based patient-centered approach to create strategic efforts to improve patient accessibility to receiving hypertension treatments.

Ensuring equity in treatment intensification will require health organizations to focus on why differences are present in today's healthcare system. Clinicians may avoid intensifying treatments for Black patients based on bias in their beliefs about their education levels, financial issues, refusal of medicine, and their lifestyle choices. Black patients may have a poor trust in clinicians of a different race and may be more prone to resist treatment for high BP. To address racial and ethnic inequities, clinicians must focus on cultural differences while developing treatment plans to increase patient engagement, improve patient-provider communication, and encourage clinicians to perform more guideline-based treatments.

Patient-centered care is the key

It is important for providers to become more engaged with patients regarding their lifestyle, cultural beliefs, and treatment concerns to gain more trust and respect from patients. A study showed that patient-centered communication about a person’s blood pressure medications led to more patients taking their medications for a longer period of time. Clinicians who develop a deeper understanding of a patient's past experiences can become a mediator between perceived discrimination and medication adherence. These efforts can go a long way to reducing the fatal (but preventable!) diseases hypertension can cause.

The Firefly Way

Our Firefly care teams take this patient-centered approach to treating blood pressure. Patients work with our clinicians conveniently through virtual visits and remote monitoring devices. Our health guides assist patients with healthy habits known to reduce blood pressure such as increasing exercise, reducing dietary salt, and stopping smoking. Through this exceptionally convenient, patient-centered, team based approach, we are able to manage blood pressure 45% better than traditional primary care practices. 

Consult your Firefly team

Virtual primary care allows you to take back control of your health at your convenience, including managing your high blood pressure. Be sure to reach out to your care team with any questions through the Firefly app.

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