A research article published this month in the Mayo Clinic Proceedings emphasizes the significant impact of the social determinants of health on the ability of patients to maintain control of their hypertension. This large clinical trial, conducted at Ochsner Health, points to the need for health systems and society to improve practices and better identify, measure and address significant barriers to health.
The main objective of the clinical trial was to determine whether specific social determinants of health created an otherwise invisible barrier for those seeking to control their blood pressure. Additionally, the trial aimed to determine whether hypertension control was significantly different for the black population compared to white individuals.
Social determinants are prevalent in the hypertensive patients we manage, and in anyone with a chronic disease. These identified barriers have a direct impact on our ability to control hypertension.”
Richard Milani, MD, vice president of cardiology, Ochsner Health, and senior author of the article
The trial used digital tools such as smart phones, a wireless blood pressure measuring unit and a digital management program for enrollees with high blood pressure. Participants received regular questionnaires assessing factors related to hypertension, including dietary sodium and alcohol intake, depression, medication adherence, physical activity, and screening for obstructive sleep apnea . Researchers gathered additional information that impacts chronic disease management, including patient activation, which measures an individual’s willingness and ability to take independent action to manage their health and care. The study also measured financial stress against the cost of their medications and health literacy. These measures were collectively referred to as “sanitary barriers”.
“We have been studying disparities in health outcomes among black populations in the United States for years. Historically, compared to whites, black people have suffered worse health outcomes related to heart disease, diabetes, cancer, maternal mortality and infant mortality. said Eboni Price-Haywood, MD, Medical Director, Ochsner Xavier Institute for Health Equity and Research. “Disparities in hypertension control are not different because blacks have significantly lower rates of hypertension control than whites. However, what this study shows is that social determinants play a important role in an individual’s ability to maintain healthy blood pressure levels, and this further reinforces the need for further research in this area.”
The study evaluated more than 3,300 patients with uncontrolled blood pressure and found that, regardless of race, the presence of any of the three barriers measured significantly decreased blood pressure control. People with poorly controlled, barrier-free hypertension achieved control rates of 73% at 1 year. The rate of blood pressure control for people with one barrier decreased to 60%, while people with two or more barriers further decreased to 55%.
Blood pressure control remains a high priority nationwide, as it has a direct impact on the risk of cardiovascular disease and mortality in adults with hypertension. Additionally, data from the Centers for Disease Control and Prevention reveals that hypertension control rates are highest in white patients (55.7%) and lowest in black patients (48.5%). . This translates into higher death rates from hypertension in black patients. Some have concluded that this may be due to racial differences in the ability to control blood pressure. However, as this study found, when two or more barriers to health are indicated, differences in blood pressure control rates between black patients and white individuals are eliminated, suggesting that social determinants, and not race, have a more negative impact on blacks than on whites.
“Social and economic disparities are really the biggest driver of blood pressure control between black and white patients, and there’s no inherent race-based susceptibility,” Dr. Milani said.
As noted in the article, further research is needed to determine appropriate methods to identify and mitigate these barriers to health.