Andi Shahu|Jeph Herrin|Sanket S. Dhruva|Nihar R. Desai|Barry R. Davis|Harlan M. Krumholz|Erica S. Spatz
Disparities in Socioeconomic Context and Association With Blood Pressure Control and Cardiovascular Outcomes in ALLHAT
Johns Hopkins Hospital|Yale University|Health Research and Educational Trust|San Francisco VA Medical Center|University of California, San Francisco|Yale University|Yale New Haven Hospital|Yale University|Yale New Haven Hospital|Yale New Haven Health System|Yale University|Yale New Haven Hospital
background observational studies demonstrate communities low socioeconomic status higher blood pressure worse cardiovascular outcomes yet whether clinical outcomes resulting antihypertensive therapy vary socioeconomic context randomized clinical trial participants treated standard protocol unknown methods results used data allhat antihypertensive lipidlowering treatment prevent heart attack trial study effect socioeconomic context defined countylevel median household income study sites stratified sites income quintiles compared characteristics blood pressure control cardiovascular outcomes among allhat participants lowest highestincome quintiles among 27 862 qualifying participants 2169 78 received care lowestincome sites quintile 1 10 458 376 received care highestincome sites quintile 5 participants quintile 1 likely women black hispanic fewer years education live south fewer cardiovascular risk factors adjusting baseline demographic clinical characteristics quintile 1 participants less likely achieve blood pressure control lt14090 mm hg odds ratio 048 95 ci 037063 greater allcause mortality hazard ratio hr 125 95 ci 110141 heart failure hospitalizationsmortality hr 126 95 ci 103155 endstage renal disease hr 186 95 ci 126273 lower angina hospitalizations hr 070 95 ci 059083 coronary revascularizations hr 071 95 ci 057089 conclusions despite standardized treatment protocols allhat participants lowestincome sites experienced poorer blood pressure control worse outcomes adverse cardiovascular events emphasizing importance measuring addressing socioeconomic context clinical trial registration url httpwwwclinicaltrialsgov unique identifier nct 00000542