Consistency of Care and Blood Pressure Control among Elderly African Americans and Whites with Hypertension

Objective: To determine whether racial differences exist between consistency of medical care and blood pressure (BP) control over time among elderly, hypertensive African Americans and whites. Design: Participants included 1402 African Americans and 1058 whites from the Piedmont Health Survey of the Elderly who were hypertensive (systolic BP >= 140 mm Hg, diastolic BP >= 90 mm Hg, or used antihypertensive medications) at baseline (in 1987). Consistency of care was assessed based on self-reported receipt of physician care at each wave and categorized as consistent (care at each wave); inconsistent (care at some, but not all waves); or no standard care (no care at any wave). BP control was defined as systolic BP <140 mm Hg and diastolic BP <90 mm Hg at subsequent waves of participation (in 1990, 1994, and 1998). Repeated measures regression was used to longitudinally assess the association between consistency of care and BP control. Results: African Americans had a less favorable health profile and significantly less consistency of care over time (P < .0001). In analyses adjusted for demographic factors, participants with consistent or inconsistent care had greater odds of BP control (odds ratio, 1.34; 95% CI, 1.09-1.64 and odds ratio, 1.41; 95% CI, 1.12-1.78, respectively) than those with no standard care, but these associations were attenuated after additional adjustment for health care characteristics and comorbidities. Conclusions: Compared with no standard care, receipt of consistent or inconsistent physician care was associated with BP control among the elderly. These associations did not differ by race, although African Americans were more likely to report inconsistent or no standard care, which suggests that disparities in health care access remain. (J Am Board Fam Med 2009;22:307-15.)