Online Program

Diabetes mellitus and uncontrolled blood pressure: The aspect of racial disparity in diagnosed hypertensive patients

Monday, November 4, 2013

Joseph Ikekwere, MD, Biostatistics and Epidemiology, East Tennessee State University, Johnson City, TN
Joshua Longcoy, MPH, Biostatistics and Epidemiology, East Tennessee State University, Johnson City, TN
Xuefeng Liu, PhD, Biostatistics and Epidemiology, East Tennessee State University, Johnson City, TN
Clinical evidence indicates diabetes mellitus (DM) may lead to uncontrolled blood pressure (BP) in hypertensive patients. However, racial differences in the associations between DM and uncontrolled BP outcomes among diagnosed hypertensive patients have not been evaluated. The goal of this study was to evaluate and identify if race influenced the association between DM and dynamic hypertension subtypes in a sample of hypertensive patients. NHANES data collated from five surveys (1999-2008) was used to evaluate 6,147 non-Hispanics Blacks, Mexicans, and non-Hispanic Whites. Odds ratio (ORs), 95% confidence intervals (CIs) of uncontrolled BP, and effect differences in continuous BP for DM over race/ethnicity were derived using weighted regression models. After adjustment for potential confounders, participants with diabetes had 138% (OR: 2.38, 95% CI: 1.77-3.18), 60% (OR: 1.60, 95% CI: 1.01-2.52), and 161% (OR: 2.61, 95% CI: 2.02-3.38) higher chances of having uncontrolled BP in non-Hispanic Blacks, Mexicans, and non-Hispanic Whites, respectively. The association between DM and uncontrolled BP was lower in Mexicans than in non-Hispanic Blacks and Whites. Participants with DM had 90% (OR: 1.90) and 114% (OR: 2.14) higher chances of having uncontrolled isolated systolic BP in non-Hispanic Blacks and non-Hispanic Whites than Mexicans, respectively. The higher prevalence of DM in non-Hispanic Blacks and Mexicans did not translate into a stronger association of DM with uncontrolled BP outcomes. The stronger association of DM with BP outcomes in non-Hispanic Whites compared to Mexicans should be of public health education considering they account for the majority of hypertensive population in the United States.

Learning Areas:

Advocacy for health and health education
Clinical medicine applied in public health
Public health or related education
Public health or related research
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Evaluate and identify racial disparity in the associations of Diabetes mellitus with uncontrolled blood pressure. Compare and determine if the higher prevalence of Diabetes mellitus in non-Hispanic blacks and Mexicans translate into a stronger association with uncontrolled blood pressure outcomes.

Keyword(s): Diabetes, Hypertension

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have managed diabetic and hypertensive patients at several levels as a physician. As a master's of public health (MPH) candidate, my area of interest is in evaluating and comparing various aspects of racial disparities as it relates to these chronic diseases. Also, I did epidemiologic literature reviews and data analyses.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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