Racial disparities in hypertension awareness and management: Are there differences among African Americans and Whites living under similar social conditions?

Objective: To examine the nature of disparities in hypertension awareness, treatment, and control within a sample of Whites and African Americans living in the same social context and with access to the same health care environment. Design: Cross-sectional study Setting: Southwest Baltimore, Maryland Participants: 949 hypertensive African American and White adults in the Exploring Health Disparities in Integrated Communities-Southwest Baltimore (EHDIC-SWB) Study. Main Outcome Measures: Hypertensive participants who reported having been diagnosed by a doctor were considered to be aware of their hypertension. Among hypertensive adults aware of their condition, those who reported taking antihypertensive medications were classified as being in treatment. Among the treated hypertensive adults who had diabetes, those with systolic BP<130 mm Hg and diastolic BP<80 mm Hg were considered to be controlled. Among the treated hypertensive participants who did not have diabetes, those with systolic BP<140 mmHg and diastolic BP<90 mm Hg were also considered to be controlled. Results: After adjusting for age, sex, marital status, education, income, health insurance, weight status, smoking status, drinking status, physical activity, cardiovascular disease, stroke, and diabetes, African Americans had greater odds of being aware of their hypertension than Whites (odds ratio51.44; 95% confidence interval 1.04, 2.01). However, African Americans and Whites had similar odds of being treated for hypertension, and having their hypertension under control. Conclusion: Within this racially integrated sample of hypertensive adults who share similar health care markets, race differences in treatment and control of hypertension were eliminated. Accounting for the social context should be considered in public health interventions to increase hypertension awareness and management.