Hypertension and other chronic conditions disproportionately affect people from ethnic and racial minorities, who often live in resource-constrained communities and face historical or systemic disadvantage. Addressing these inequalities is critical both for responses to COVID-19 and for long-term chronic disease management approaches.
âMedia coverage has examined how and why COVID-19 is disproportionately impacting communities of color to some extent,â lead author Adam Bress, PharmD, MS, associate professor of population health sciences in the division of innovation and health system research at the University of Utah School of Medicine in Salt Lake Sity, said in a statement. âHowever, it is essential that we continue to examine and explain to what extent the pandemic has widened the racial divide. [or] ethnic and class groups in the United States and exposed the systemic and institutional cracks in our health care system in terms of health care equity for underrepresented people and populations facing disadvantage.
A panel of clinicians, investigators and leaders from various walks of life recently met to discuss how the COVID-19 pandemic has deepened inequalities in hypertension control and to examine environmental and socio- factors. economic factors that contribute to disparities within the health care system. They also aimed to develop strategies to help close the gap in the future.
Large national study of more than 50,000 adults found that the number of people maintaining healthy blood pressure (BP) levels declined even before the pandemic, and lack of access to health care and health insurance were the main contributing factors. BPH in this study was defined as greater than 140/90 mm Hg, although American Heart Association guidelines define BPH as greater than 130/80 mm Hg.
This study found that between 2017 and 2018, only 22% of the uninsured people in the study had healthy BP levels, compared to 40% to 46% of those who had some form of health insurance. In addition, only 8% of people who had not seen a healthcare professional in the past year had their BP under control, compared to 47% of those who reported seeing a healthcare professional. The results also suggested that black adults were 12% less likely to have healthy BP levels than white adults.
The COVID-19 pandemic has caused a major shift in healthcare, with the shift from in-person medical visits to virtual medical visits. While virtual visits can be convenient for many patients, this also presents a challenge as many people do not have access to validated home BP monitors. This lack of access to devices, along with a lack of internet access or inadequate digital literacy to participate in virtual dates, have posed significant barriers.
Another barrier to controlling BP is lack of adherence to lifestyle changes and medications. Limited trips to grocery stores or doctor’s offices have also resulted in limited access to advice and healthy foods, which can have a negative effect on hypertension.
The committee also noted that mistrust of the health care system is a major obstacle to controlling BP. This distrust is fueled by decades of institutional racism and historic atrocities in medical research, such as Tuskegee’s study of syphilis in black men. To address this mistrust, the panel noted that community interventions can help build confidence and improve access to health care.
One essay illustrating the importance of community interventions was the BARBER trial, in which barber shops in predominantly black neighborhoods in Los Angeles were used to encourage people to meet pharmacists, who were regularly integrated into barber shops. Hair salons have also promoted healthy lifestyle choices with routine care by doctors.
At 6 months, people who participated in the intervention achieved a 21.6 mm Hg greater reduction in systolic BP and a 51.9% greater increase in BP control than those who received no intervention. These results were maintained at 12 months.
Finally, the committee noted a lack of diversity among researchers, medical students and research participants. The results of an analysis found that among all hypertension trials registered in the United States, only 5.4% recruited exclusively black adults, suggesting that there are few approaches and interventions. specifically studied for this population.
“Too often, individuals are blamed for their health care conditions, without considering the multiple levels of social and context factors that contribute to persistent and pervasive health inequalities,” said Bress.
âHealth inequalities are a problem of social justice,â she said. “We need to be more direct and honest about the reasons for health disparities today and engage in structural solutions to start addressing them.”
The COVID-19 pandemic has amplified health inequalities for people with high blood pressure. Press release. American Heart Association. May 19, 2021. Accessed May 21, 2021. https://newsroom.heart.org/news/covid-19-pandemic-magnified-health-inequities-for-people-with-high-blood-pressure?preview=1605