A 64-year-old Asian man presents to the clinic for the first time for evaluation. Before entering the room, the clinician reviews the patient's vital signs, which are significant for a BP 151/92 mm Hg (similar to a previous reading of 149/91 mm Hg obtained at his primary care provider's office 1 month earlier).
After confirming with the nurse that the correct measurement techniques were used to obtain today's BP, the clinician recognizes that the patient may not be aware of the importance of his BP in reducing his risk of cardiovascular disease.
There are significant differences in BP awareness, control, and treatment rates based on race and ethnicity.
Show Answer
The correct answer is: Fact
Large differences exist in the awareness, treatment, and control rates of hypertension (HTN) across different racial and ethnic groups. In the American Heart Association (AHA) Heart Disease and Stroke Statistics-2020 Update, awareness, treatment, and control of HTN among Asian men were reported as being lower than among non-Hispanic White and non-Hispanic Black men but higher than among Hispanic men.1 Similar findings were observed for Asian women.1
Regarding this patient, only 50.3% of Asian men with HTN are aware of their diagnosis, with fewer receiving treatment (38.8%) or achieving BP control (13.6%).2 After multivariable adjustment, compared with non-Hispanic White individuals, Asian American individuals are 25% less likely to be aware of their HTN, 19% less likely to have their HTN treated, and 32% less likely to achieve control of their HTN.3
Whereas awareness levels are more evenly distributed across racial and ethnic groups, control rates for non-White individuals are lower than in their non-Hispanic White counterparts. Understanding the causes of these differences is critical to reduce disparities in care delivery and health care outcomes. Social determinants of health such as health literacy, socioeconomic status, and access to health care are major contributors to observed differences in BP control rates and awareness among racial and ethnic minority groups in the United States (Figure 1).4
Figure 1: Extent of Awareness, Treatment, and Control of High BP by Race/Ethnicity and Sex, United States (NHANES, 2013-2016)
Figure 1
NH = non-Hispanic; NHANES = National Health and Nutrition Examination Survey.
Adapted with permission from Virani SS, Alonso A, Benjamin EJ, et al.; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics-2020 update: a report from the American Heart Association. Circulation 2020;141:e139-e596.
NH = non-Hispanic; NHANES = National Health and Nutrition Examination Survey.
Adapted with permission from Virani SS, Alonso A, Benjamin EJ, et al.; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics-2020 update: a report from the American Heart Association. Circulation 2020;141:e139-e596.
This patient case quiz is part of the larger Overcoming Challenges in Hypertension Management grant. Educational grant support is provided by Medtronic. To visit the Overcoming Challenges in Hypertension Management grant page and access additional educational activities on this topic, click here.
References
Virani SS, Alonso A, Benjamin EJ, et al.; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics-2020 update: a report from the American Heart Association. Circulation 2020;141:e139-e596.
National Center for Health Statistics. NHANES Questionnaires, Datasets, and Related Documentation (Centers for Disease Control and Prevention website). Available at: https://wwwn.cdc.gov/nchs/nhanes/Default.aspx. Accessed 03/01/2024.
Aggarwal R, Chiu N, Wadhera RK, et al. Racial/ethnic disparities in hypertension prevalence, awareness, treatment, and control in the United States, 2013 to 2018. Hypertension 2021;78:1719-26.
Abrahamowicz AA, Ebinger J, Whelton SP, Commodore-Mensah Y, Yang E. Racial and ethnic disparities in hypertension: barriers and opportunities to improve blood pressure control. Curr Cardiol Rep 2023;25:17-27.
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