Getting control of hypertension: Social determinants of treatment and control

Background: Hypertension is a major risk factor for cardiovascular disease, a leading cause of death for Americans that accounts for one-third of the mortality disparity between non-Hispanic Black and non-Hispanic White Americans. In previous research, we found higher rates of hypertension prevalence, but lower rates of awareness, treatment and control, among residents of Detroit, Michigan when compared to the United States. Non-Hispanic Blacks were more likely to be aware of their hypertension, but paradoxically, had lower treatment and control rates than non-Hispanic White Detroit residents. Data and Methods. We build on previous findings to examine individual (e.g., household income) and neighborhood level (e.g., neighborhood poverty level) predictors of hypertension treatment and control. Data are from a two-stage random probability sample of Detroit residents (≥25 years), conducted by the Detroit Healthy Environments Partnership, a community-based participatory research partnership. Two level hierarchical linear models test the hypothesis that neighborhood socioeconomic characteristics (e.g., percent below poverty) are associated with prevalence, awareness, treatment and control of hypertension among non-Hispanic Blacks, non-Hispanic Whites and Latinos, and that these associations partially account for lower rates of treatment and control among non-Hispanic Blacks. Results & Implications. Results from these analyses inform priorities for intervention by identifying characteristics of urban residential neighborhoods associated with effectiveness of hypertension treatment and control. We discuss implications for public health efforts to control hypertension, with attention to social determinants of treatment and control among non-Hispanic Black residents of low to moderate income urban communities.