Differences In Shared Decision Making Among Patients With Hypertension

Background: Shared decision-making (SDM) is sanctioned by US legislation and promoted by hypertension guidelines. However, evidence is scarce for ethnically diverse groups. We aimed to examine the relationships between SDM, blood pressure, self-identified race/ethnicity, and baseline characteristics among patients with hypertension. Methods and results: Secondary data analysis of a pragmatic clinical trial with individuals with uncontrolled hypertension using linear regression and generalized estimating equations. Participants (n=1426) were predominantly middle-aged (mean 60 years ± 11.6), female (59.4%, 847), non-Latino Black people (59%, 844), and high school graduates or below (65%, 931). SDM was averaged at 7.2 (±2.6) out of 9, SBP at 152.2 (±12.0), and DBP at 85.3 (±12.1) mmHg. We found a greater reduction in SBP over time with higher SDM mean score (B -0.44, p 0.032). Positive association was found between SDM and patient activation (B 0.01, p=0.001), considering taking blood pressure medication as very important (B 0.56, p=0.022), and patients’ self-reported race/ethnicity. Non-Latino Black people had 0.74 points higher mean SDM score (p<0.001) than Non-Latino White people. On the contrary, the association was negative for knowing that high blood pressure is the same as hypertension (B -0.35, p 0.046), and education. Those with more than high school education had lower mean SDM (B -0.44, p 0.045). Conclusions: Future research should further explore SDM differences among racial/ethnic groups to better align care with needs of patients with hypertension. Our results offer actionable information to enhance clinical practice and policy development.