Ethnic differences in blood pressure control among men at veterans affairs clinics and other health care sites

Background: Differential access to health care may contribute to lower blood pressure (BP) control rates to under 140/90 mm Hg in African American compared with white hypertensive patients, especially men (26.5% vs 36.5% of all hypertensive patients in the National Health and Nutrition Examination Survey 1999-2000). The Department of Veterans Affairs (VA) system, which provides access to health care and medications across ethnic and economic boundaries, may reduce disparities in BP control. Methods: To test this hypothesis, BP treatment and control groups were compared between African American (VA, n = 4379;non-VA, n = 2754) and white (VA, n = 7987; non-VA, n:=4980) hypertensive men. Results: In both groups, whites were older than African-Americans (P <.05), had lower BP (P <.001),and had BP controlled to below 140/90 mm Hg more often on their last visit (P <.01). Blood pressure control to below 140/90 mm Hg was comparable among white hypertensive men at VA (55.6%) and non-VA (54.2%) settings (P = .12). In contrast, BP control was higher among African American hypertensive men at VA (49.4%) compared with non-VA (44.0%) settings (P <.01), even after controlling for age, numerous comorbid conditions, and rural-urban classification. African American hypertensive men received a comparable number of prescriptions for BP medications at VA sites (P = .18) and more prescriptions at non-VA sites than did whites (P <.001). African Americans had more visits in the previous year at VA sites (P <.001) and fewer visits at non-VA sites (P <.001) compared with whites. Conclusions: The ethnic disparity in BP control between African Americans and whites was approximately 40% less at VA than at non-VA health care sites (6.2% vs 10.2%; P <.01). Ensuring access to health care could constitute one constructive component of a national initiative to reduce ethnic disparities in BP control and cardiovascular risk.