Center for Healthcare Innovation, New Orleans, LA; Ochsner Health System, and Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School - University of Queensland School of Medicine, New Orleans, LA.
Center for Outcomes and Health Services Research, New Orleans, LA.
Mayo Clin Proc. 2022 Aug;97(8):1462-1471. doi: 10.1016/j.mayocp.2022.01.035. Epub 2022 Jul 19.
To investigate whether specific social determinants of health could be a "health barrier" toward achieving blood pressure (BP) control and to further evaluate any differences between Black patients and White patients.
We conducted a retrospective cohort study of 3305 patients with elevated BP who were enrolled in a hypertension digital medicine program for at least 60 days and followed up for up to 1 year. Patients were managed virtually by a dedicated hypertension team who provided guideline-based medication management and lifestyle support to achieve goal BP.
Compared with individuals without any health barriers, the addition of 1 barrier was associated with lower probability of control at 1 year from 0.73 to 0.60 and to 0.55 in those with 2 or more barriers. Health barriers were more prevalent in Black patients than in those who were White (44.6% [482 of 1081] vs 31.3% [674 of 2150]; P<.001). There was no difference at all in BP control between Black individuals and those who were White if 2 or more barriers were present.
Patient-related health barriers are associated with BP control. Black patients with poorly controlled hypertension have a higher prevalence of health barriers than their White counterparts. When 2 or more health barriers were present, there was no differences in BP control between White and Black individuals.
探究特定的健康社会决定因素是否会成为实现血压控制的“健康障碍”，并进一步评估黑人和白人患者之间的差异。
我们进行了一项回顾性队列研究，纳入了 3305 名血压升高的患者，他们参加了高血压数字医学计划至少 60 天，并随访了长达 1 年。由专门的高血压团队对患者进行虚拟管理，提供基于指南的药物管理和生活方式支持，以达到目标血压。
与没有任何健康障碍的患者相比，存在 1 个健康障碍的患者在 1 年内控制血压的可能性从 0.73 降至 0.60，存在 2 个或更多健康障碍的患者控制血压的可能性从 0.73 降至 0.55。黑人群体中健康障碍比白人患者更为常见（44.6%[482/1081]比 31.3%[674/2150]；P<.001）。如果存在 2 个或更多健康障碍，黑人个体和白人个体的血压控制之间没有差异。
与患者相关的健康障碍与血压控制有关。血压控制不佳的黑人患者比白人患者有更高的健康障碍发生率。当存在 2 个或更多健康障碍时，白人和黑人患者的血压控制没有差异。
