TITLE: Reducing the Racial Disparity in CV Disease Through Better BP control ABSTRACT. Background. Hypertension clearly contributes to the racial disparities in health outcomes. The Charleston Health Study indicated that hypertension contributed to approximately 40% of deaths in African Americans compared to 20% in Caucasians/1. The prevalence and complications are hypertension are greater and control rates lower among hypertensive patients of lower socioeconomic status (SES) which are disproportionately African American/2. For these and other reasons, African Americans in South Carolina continue to die from stroke at double the rate of caucasians/3. The hypertension Detection and Follow- up Program (HDFP) showed that stepped-care treatment of high blood pressure (BP) reduced stroke and total mortality more in African Americans than in caucasians/4. Although access to care is a significant issue for low income individuals, especially the uninsured, control of hypertension to <140/90 mmHg is obtained on greater than or equal to 75% of visits in only approximately 20% of patients. Therefore, a logical approach to optimizing BP control rates in the population is to first improve efficiency, i.e., do a better job with the >50% of hypertensive patients who are already in the system but the majority of whom are not consistently at the goal BP/5. Once that is accomplished, then improving access will lead to a more efficient utilization of resources and greater control rates. Reluctance off providers to increase therapy is a major contributor to inadequate BP control/6. An outpatient hypertension management program at Univ. of Pennsylvania, which focused on providers, increased BP control rates from 19-53% within one year/7. Thus, our initial focus and the principal emphasis of this proposal is on the provider and treatment of hypertension and associated risk factors. Hypothesis. Raising provider awareness through a either local Hypertension Expert or feedback on BP control for individual patients will be more effective than traditional continuing medical education (CME) in improving BP control rates. Study design. Using a randomized design, we propose to identify primary care providers in geographically separate areas serving a large proportion of lower income African American patients, Given an aging population, a disproportionate increase of systolic BP with aging, and the fact that systolic BP is less often controlled than diastolic BP and contributes to cardiovascular events and dementia, practices serving a high proportion or elderly African Americans will be selected Practices will be randomly allocated to one of three groups. (1) Hypertension Expert-Selected providers will be trained as the group expert (opinion leader) to (a) develop goals and practice guidelines for implementation in their practice (b) educate their peers and provide consultations on uncontrolled hypertensive patients and (c) participate in evaluating B control at their site. (2) Feedback on BP control. These providers will receive written feedback on treatment goals and control for individual hypertensive patients in their practice. (3) Hypertension CME. Providers at these sites will receive hypertension CME on JNC VI guidelines. BP control rates at one year will be assessed by chart review.
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