The Article in Brief

Ethnic Disparities in Blood Pressure Management in Patients With Hypertension After the Introduction of Pay for Performance

Christopher Millett , and colleagues

Background The United Kingdom (UK) has implemented a major quality improvement effort, which includes a goal of reducing inequalities in the management of chronic diseases. This study examines differences in the management of high blood pressure by patient ethnicity in the United Kingdom.

What This Study Found Black patients with high blood pressure are less likely to reach an established treatment target for blood pressure control than white or South Asian patients. South Asian patients with high blood pressure have more cardiovascular conditions than white or black patients. The presence of two or more other cardiovascular conditions was associated with better blood pressure control in white but not in black or South Asian patients. South Asian patients with poorly controlled blood pressure were prescribed fewer antihypertensive medications than black or white patients.

Implications

• Ethnic inequalities in the management of high blood pressure have continued in the United Kingdom despite major investment in quality improvement programs, including pay for performance.
• These disparities are particularly marked in patients with additional cardiovascular conditions.
• In universal quality improvement programs, such as pay for performance, additional efforts are required to improve the quality of care for high-risk individuals.