Treatment Of Black Patients Research Articles

343 Regional Variability in the Management of Aneurysmal Subarachnoid Hemorrhage for Black Patients: An Analysis of Treatment Patterns, Outcomes, and End-of-life Care.

INTRODUCTION: Disparities in the care of Black Americans with aneurysmal subarachnoid hemorrhage (aSAH) have been described. However, regional variations for Black patients with aSAH have yet to be delineated, particularly in end-of-life care. METHODS: We analyzed aSAH data from the Nationwide Inpatient Sample (NIS) from 2016-2020. Controlling for covariates, multivariate logistic regression models were used to assess U.S. Census region differences between Black and White patients in treatment, adverse outcomes, mortality, use of palliative care as well as do not resuscitate (DNR) and of life-sustaining interventions (mechanical ventilation, tracheostomy, gastrostomy, blood transfusion). RESULTS: Black patients in the East-North Central (ENC) division were less likely to have inpatient morality following aSAH (OR 0.68, 95% CI 055 – 0.83, p <0.001), yet more likely to have tracheostomy (OR 1.83, 95% CI 1.39 - 2.49, p < 0.001) and gastrostomy (OR 1.66, 95% CI 1.31 - 2.11, p < 0.001) tube placement than the national average. Furthermore, Black patients in the ENC were less likely to have palliative care (OR 0.42, 95% CI 0.22 - 0.80, p = 0.008) This trend continued in the West South-Central (WSC) division for tracheostomy (OR 1.86, 95% CI 1.29 - 2.66, p = 0.001), gastrostomy (OR 1.95, 95% CI 1.44 - 2.63, p < 0.001), and palliative care (OR .67, 95% CI 0.51 - 0.87, p = 0.003). CONCLUSIONS: Geographic variations exist in the treatment of Black patients with aSAH. Nationally and regionally Black patients have lower mortality rates than White patients, due in part to disparities in end-of-life care. Black patients receive more life-sustaining interventions, and less palliative care and DNR; this is most evident in the ENC and WSC regions. Paradoxically, regions with more Black residents fare worse.

Racial disparity in the utilization of immunotherapy for advanced prostate cancer

PurposeTo identify whether there was a disparity in the utilization of immunotherapy in the treatment of black patients with metastatic castration resistant prostate cancer (mCRPC). MethodsUsing the National Cancer Database, we identified patients between 2010- 2015 with likely minimally/asymptomatic mCRPC. We analyzed annual trends for chemotherapy and immunotherapy use and compared utilization by demographic and clinical features. Multivariable analysis was performed to determine predictors of receiving immunotherapy vs chemotherapy. ResultsWe identified 1301 patients with likely mCRPC. The majority were non Hispanic White (NHW - 63 %) and 23 % were non-Hispanic Black (NHB). Overall, there was increased utilization of immunotherapy in mCRPC from 2010 onwards, with the peak occurring in 2014 (4.6 %). Chemotherapy use increased significantly, peaking in 2014 to 26.1 %. However, the increased utilization of immunotherapy in the mCRPC was mainly seen in White patients: from 50 % to 74.2 % of the cohort. Conversely, there was a decrease in utilization of immunotherapy among Black mCPRC patients: from 50 % to 25.8 %. On multivariable analysis, there was no statistically significant difference between treatment types by race. ConclusionFDA approval of Sipuleucel-T for mCRPC led to increased utilization of immunotherapy shortly thereafter, but this was mainly noted in white patients. Black patients comparatively did not exhibit increased utilization of this novel agent after 2010. Further studies are necessary to help understand barriers to access to new treatment in mCRPC and eliminate the burden of disease in minority populations."

P9: Teaching Health Disparities as Regards Cardiopulmonary Support Technologies for Underepresented/ Underserved Patients

Background: There is a growing interest in addressing health care disparities faced by underrepresented/ underserved (U/U) populations across all fields of medicine. To that end, my goal was to introduce to the undergraduate (UG) and graduate (G) bioengineering classes that I teach the challenges faced by U/U patients as regards state-of-the art cardiopulonary support technologies (CPST) for treatment of end-stage cardiac or pulmonary failure. Methods: At the University of Pittsburgh (UoP) I teach two separate UG artificial organs (AO) classes; one class focuses on cardiac assist devices and the other on pulmonary assist devices. I also teach the cardiac assist module for a G cardiovasuclar organ replacement class. Through a long-standing NSF-funded collaboration with North Carolina Agricultural and Technical State University (Greensboro, NC), a Historically Black College and University (HBCU), I also teach my AO classes to NCAT students. The NCAT courses are taught remotely (via ZOOM). For the past several years, the term projects for my UG and G artificial organs classes at UoP and NCAT have focused on i) investigating health inequities/ disparities in CPST as applied to U/U patients; and, ii) proposing innovative improvements to current CPST that benefit, particularly, U/U patients. Students are asked to address the following in their term papers and class PPT presentations: 1) current state-of-the art in CPST; 2) limitations of current CPST as applied to U/U patients; 3) unmet clinical needs for U/U patients; 4) the feasibility of the proposed innovative improvements from a product specification, regulatory and societal viewpoint. Results: Students identified numerous reference materials that highlight the inequities/ disparities that U/U patients face. The American Heart Association, the CDC and NHLBI all maintain detailed epidemiological information related to the term project topic. There also exists a plethora of peer-reviewed published articles in this regard; a few examples being, Frech et al, “Ventricular Assist Device Technology and Black-White Disparities on the Heart Transplant Wait List.” Progress in Transplantation 2021; 31(1): 80-87; Nyak et al, “Understanding the Complexity of Heart Failure Risk and Treatment in Black Patients.” Circulation Heart Failure 2020; 13: 301-314. Among the student term project topics were, “Improving VAD Technology for the African American Community;” “Blood Pressure Measurement and Management in Black Ventricular Assist Device Users;” “A Multi-Factor Approach to Improve African American Heart Health;” “Innovative Design for Cystic Fibrosis in Women of Color.” Conclusions: Student response to the term project assignment was positive. Meetings with the students demonstrated the students’ interest in the topic. The ultimate success of this assignment will be achieved, if these students are sensitive to the special needs of U/U patients and incorporate these needs in their design of biomedical devices.

CLL-449 Patterns of Treatment and Prognostic Testing Among Black Patients With Chronic Lymphocytic Leukemia (CLL): Results From informCLL, a Prospective, Observational Registry

To evaluate real-world treatment patterns and prognostic biomarker testing in Black patients with CLL enrolled in informCLL. informCLL, a US-based, prospective, observation registry, enrolled patients who initiated FDA-approved treatment for CLL/SLL (October 2015 - June 2019). Baseline characteristics, FISH testing rates, and patterns of treatment were summarized by lines of therapy (LOT). Of 1462 enrolled patients, 106 (7%) were Black. Black patients were predominantly enrolled in the South (69%) and from community-based practices (87%). Compared with the overall registry population, Black patients were younger (median age 66 years vs 71 years), had higher proportions with ECOG status ≥1 (65% vs 53%) and Rai stage III-IV (64% vs 51%), and similar time from diagnosis to treatment on registry (median 40 months vs 41 months) but shorter time from diagnosis to first-line treatment (median 7 months vs 19 months). FISH testing rates were similar (25% vs 28%). In a multivariate analysis (performed in overall registry population), baseline factors associated with FISH testing were shorter time from diagnosis to treatment, better ECOG status, earlier LOT (first-line), community practice setting, and a prior malignancy (p<0.05 for all); race was not a predictive factor. As observed in the overall population, ibrutinib was the most frequent treatment among Black patients in first-line (50%) and R/R (67%) settings, followed by chemoimmunotherapy (first-line, 43%; R/R, 15%). In the first-line cohort, ibrutinib use generally increased over time (2016, 31%; 2017, 57%; 2018, 63%; 2019, 55%) while chemoimmunotherapy use persisted (56%, 36%, 38%, and 36%, respectively). In R/R patients, ibrutinib use decreased over time while chemoimmunotherapy remained consistent. In informCLL, Black patients with CLL tended to be younger, with worse ECOG status, more advanced disease, and shorter time to first-line therapy than the overall registry population. Black patients may need close monitoring of disease status as they will tend to require initial CLL therapy more rapidly than other patients. Although ibrutinib was the most common treatment in Black patients, chemoimmunotherapy use remained persistent. Prognostic testing rates were suboptimal in Black patients, similar to the overall population. ©2022 American Society of Clinical Oncology, Inc. Reused with permission. This abstract was accepted and previously presented at the 2022 ASCO Annual Meeting. All rights reserved.

34038 Race associated with delays in time to initial treatment and radiation for patients with mycosis fungoides: A retrospective, cross-sectional analysis of the National Cancer Database from 2004-2017

Background: Studies have shown that Black patients (BPs) with mycosis fungoides (MF) have a poorer prognosis when compared with White patients (WPs), controlling for socioeconomic factors and types of treatment. However, differences in the time to treatment (TTT) between BPs and WPs with MF using the National Cancer Database (NCDB) have not been studied. Objective: To compare the TTT between BPs and WPs with MF within the NCDB, controlling for sex, age, median household income by zip code, insurance, stage, and type of treatment. Methods: A retrospective, cross-sectional analysis of patients diagnosed with MF from 2004 to 2017 within the NCDB was performed. Univariate logistic regression was used to compare TTTs, sociodemographic characteristics (SDCs), and stage by race. Multivariate logistic regression was used to evaluate TTT after controlling for type of treatment, SDCs, and stage. Results: Of the 8095 patients diagnosed with MF from 2004 to 2017, 593 (7.33%) BPs and 2467 (30.48%) WPs met the inclusion criteria. On multivariate analyses, BPs were more likely to receive their initial treatment (OR = 1.33, 95% CI 1.02–1.74) and radiation (OR = 2.46, 95% CI 1.11–5.46) >90 days after their diagnosis of MF compared with WPs. Conclusions: Delays in time to initial treatment and radiation for BPs persisted despite controlling for SDCs and stage. These delays may contribute to the poorer prognosis experienced by BPs with MF, as previously reported. Exploring why BPs with MF receive delayed care despite controlling for SDCs and stage may lead to important health care reform and reduced health disparities.

Understanding the Complexity of Heart Failure Risk and Treatment in Black Patients.

Although care of patients with heart failure (HF) has improved in the past decade, important disparities in HF outcomes persist based on race/ethnicity. Age-adjusted HF-related cardiovascular disease death rates are higher for Black patients, particularly among young Black men and women whose rates of death are 2.6- and 2.97-fold higher, respectively, than White men and women. Similarly, the rate of HF hospitalization for Black men and women is nearly 2.5-fold higher when compared with Whites, with costs that are significantly higher in the first year after HF hospitalization. While the relative rate of HF hospitalization has improved for other race/ethnic minorities, the disparity in HF hospitalization between Black and White patients has not decreased during the last decade. Although access to care and socioeconomic status have been traditional explanations for the observed racial disparities in HF outcomes, contemporary data suggest that novel factors including genetic susceptibility as well as social determinants of health and implicit bias may play a larger role in health outcomes than previously appreciated. The purpose of this review is to describe the complex interplay of factors that influence racial disparities in HF incidence, prevalence, and disease severity, with a highlight on evolving knowledge that will impact the clinical care and address future research needs to improve HF disparities in Blacks.

Structural Racism in American Psychiatry and APA: Part 1

Structural Racism in American Psychiatry and APA: Part 1

Survival and Treatment of Black Patients with Chronic Lymphocytic Leukemia in the Veterans Health Affairs

Background: Chronic Lymphocytic Leukemia (CLL) is the most prevalent adult leukemia in western countries and disparities in outcomes based on race have been identified. In national registry data and institutional studies, black patients were found to have worse overall survival and an earlier age at diagnosis with higher rates of adverse cytogenetics. However, racial disparities commonly correlate with access to care, comorbidities, and differences in treatment. In order to limit these potential confounders not available in other data, we studied patients in the Veterans Health Administration (VHA) network to understand differences in treatment and outcomes of black vs. non-black patients with CLL in a single care delivery system.Methods: We used the Veterans Administration Central Cancer Registry to identify patients diagnosed with CLL between September 1999 and October 2015 who were identified by race. Pharmacy records were used identify patients who received fludarabine, cyclophosphamide, rituximab, bendamustine, or chlorambucil as initial treatment of CLL. Comparisons between groups were performed with t-test or chi-square as appropriate. Comorbidity was assessed with Charlson (Romano) index and median survival by the Kaplan-Meier method. Cox proportional hazards regression modeling was used to assess associations between race and while adjusting for age, comorbidity, type of treatment, time to treatment and BMI. The study was approved the Saint Louis VA Medical Center institutional review board.Results: An initial cohort of 7155 patients with CLL was identified, of whom 2597 received chemotherapy within the VHA. Of those receiving chemotherapy, 14.8% were black (345/2597). The median year of treatment was 2006. Black patients were younger (64.0 years vs. 67.1, p<0.001) with similar mean comorbidity scores (2.3 vs. 2.2 p=0.24) compared to non-black patients. The mean time from CLL diagnosis to treatment was shorter for black patients (24.2 months vs. 28.3 p=0.02). Black patients were more likely to receive fludarabine based regimens (43.6% vs. 30.2%, p<0.001) and less likely to receive chlorambucil (25.5% vs. 32.5%, p=0.01). There were no differences based on race in treatment with bendamustine (10.4% vs. 11.4%, p=0.57), cyclophosphamide (8.6% vs. 11.0%, p=0.15) or rituximab alone (11.9% vs 14.9%, p=0.13). Second line treatment was administered to 197 black patients, which was more frequent than non-black (51.2% vs. 43.9%, p=0.01). Mean overall survival from diagnosis was 68.2 months in black patients compared to 72.5 months in non-black (p=0.07) and median overall survival was 76 vs. 83 months (p=0.051) respectively. Mean survival from start of chemotherapy (43.7 months vs. 43.6, p=0.95) in black and non-black patients and median survival was 47 vs. 50 months (p=0.34) respectively. In unadjusted analyses, black race was not associated with differences in survival after chemotherapy (hazard ratio (HR) 1.07, 95% CI:0.93-1.22, p=0.34) nor in overall survival (1.14, 95% CI:0.99-1.30, p=0.051). After adjusting for age, comorbidity index, BMI, duration of observation and treatment characteristics, black race was associated with poorer overall survival (adjusted HR 1.25, 95% CI:1.08-1.44, p=0.002) and survival after chemotherapy (adjusted HR 1.22, 95% CI:1.05-1.41, p=0.008).Conclusions: In this retrospective analysis of patients treated for CLL at the VHA, black patients had worse survival compared to non-black patients in a single health care delivery system, which limits differences in access to care. Black patients were younger and had shorter periods of observation and were more frequently given first-line fludarabine. Future studies should be performed to understand potential differences in CLL disease biology in different racial groups as a potential cause of adverse outcomes in this patient population. DisclosuresCarson:Washington University in St. Louis: Employment; Roche: Consultancy; Flatiron Health: Employment. Sanfilippo:BMS/Pfizer: Speakers Bureau.

A Review of ACE Inhibitors and ARBs in Black Patients With Hypertension.

To review current guidelines and recent data evaluating the efficacy and safety of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) in black hypertensive patients. Articles evaluating race-specific outcomes in hypertension were gathered using a MEDLINE search with keywords black, African American, ACE inhibitor, angiotensin receptor blocker, angiotensin system, and hypertension. Studies published from 2000 through April 2018 were reviewed. Six guidelines, 8 monotherapy publications, and 5 combination therapy publications included race-specific results and were included in the review. The authors individually compared and contrasted the results from each publication. Numerous monotherapy trials indicate that black patients may have a reduced blood pressure (BP) response with ACE inhibitors or ARBs compared with white patients. Conversely, additional studies propose that race may not be the primary predictor of BP response. Reduced efficacy is not observed in trials involving combination therapy. Some studies suggest increased cardiovascular and cerebrovascular morbidity and mortality with ACE inhibitor or ARB monotherapy in black patients; however, data are conflicting. Relevance to Patient Care and Clinical Practice: This article clarifies vague guideline statements and informs clinicians on the appropriate use of ACE inhibitors or ARBs for hypertension treatment in black patients through an in-depth look into the evidence. Potentially reduced efficacy and limited outcomes data indicate that ACE inhibitors or ARBs should not routinely be initiated as monotherapy in black hypertensive patients. Use in combination with a calcium channel blocker or thiazide diuretic is efficacious in black patients, and there are no data showing that this increases or decreases cardiovascular or cerebrovascular outcomes.

African American Southerners and White Physicians: Medical Care at the Turn of the Twentieth Century

Much of what scholars know about race and medicine in the late-nineteenth-and early-twentieth-century South relates to the racial beliefs of white physicians and the segregated and exploitative treatment of black patients in hospitals and public health programs. This article shifts scholarly attention to the ways African American patients and their families took part in medical practice in commonplace settings of the home and office. The author examines how African Americans called upon local physicians in the rural and small-town South, how white physicians responded, and how they interacted in cases of serious illness, injury, and surgery. The claims of black southerners to physicians' treatments, in combination with small-town physicians' continuing reliance on interpersonal practices of medical care, made for an erratic but potentially distinctive cross-racial encounter-one involving a greater degree of negotiated authority and personal care than what generally has been recognized for this time and place.

Early and Sustained Benefit on Event-Free Survival and Heart Failure Hospitalization From Fixed-Dose Combination of Isosorbide Dinitrate/Hydralazine

We previously reported that the fixed-dose combination of isosorbide dinitrate and hydralazine hydrochloride (FDC I/H) significantly decreased the risk of all-cause death and first hospitalization for heart failure (HF) and improved quality of life in patients with New York Heart Association class III or IV heart failure in the African-American Heart Failure Trial (A-HeFT). The current analyses further define the effect of FDC I/H on the timing of event-free survival (mortality or first hospitalization for HF) and time to first hospitalization for HF, as well as effects by subgroups and effects on cause-specific mortality. Kaplan-Meier analyses of the 1050 A-HeFT patients on standard neurohormonal blockade demonstrated that FDC I/H produced a 37% improvement in event-free survival (P<0.001) and a 39% reduction in the risk for first hospitalization for HF (P<0.001). These benefits appeared to emerge early (at approximately 50 days of treatment) and were sustained through the duration of the trial. Subgroup analyses of treatment effect by age, sex, baseline blood pressure, history of chronic renal insufficiency, presence of diabetes mellitus, cause of HF, and baseline medication usage demonstrated consistent beneficial effect of FDC I/H on the primary composite score and event-free survival across all subgroups. Mortality from pump failure was reduced by 75% (P=0.012). FDC I/H treatment of black patients with moderate to severe HF who were taking neurohormonal blockers produced early and sustained significant improvement in event-free survival and hospitalization for HF in the A-HeFT cohort, with significant reduction in mortality from cardiovascular and pump failure deaths. The treatment effects on the primary composite end point and event-free survival were consistent across subgroups.

Efficacy of latanoprost and timolol maleate in black and white patients

The purpose of this study was to assess the efficacy of latanoprost 0.005% and timolol maleate 0.5% in black and white patients with elevated intraocular pressure (IOP). This double-masked, randomized, 2-period crossover study included 39 eyes in 22 patients with primary open-angle glaucoma or ocular hypertension. After a 2- to 4-week washout period, patients were randomly assigned to receive either vehicle placebo in the morning and latanoprost in the evening or timolol maleate twice daily for 6 weeks. Then, after a 4-week washout period, patients received the opposing treatment for 6 weeks. Both latanoprost and timolol maleate significantly lowered IOP from baseline in both black and white patients. Latanoprost treatment was associated with lower mean IOP compared with timolol treatment in black patients (P = .013 at 8 AM, P = .19 at 10 AM). At 10 AM at the end of the treatment period, the mean +/- SD change from baseline IOP in black patients receiving latanoprost was significantly greater than that of white patients (-10.2 +/- 7.0 and -5.9 +/- 2.5 mm Hg, respectively; P = .042). The mean +/- SD change from baseline IOPs in black patients was not significantly different from that in white patients at 8 AM at the end of the treatment period for the latanoprost group and at 8 AM and 10 AM at the end of the treatment period for the timolol maleate group. In white patients, the change from baseline IOP in light (grade 1) irises was not significantly different from dark (grade 5) irises after treatment with either latanoprost or timolol maleate. In summary, intraocular pressure after treatment with latanoprost was lower than that after timolol treatment in black patients with primary open-angle glaucoma or ocular hypertension, and at 1 of 2 timepoints, latanoprost caused a significantly greater reduction of IOP in black patients than in white patients.

Which drug to choose as first-line treatment in Black patients? A four-arm randomized ABPM-guided trial in South Africa

Which drug to choose as first-line treatment in Black patients? A four-arm randomized ABPM-guided trial in South Africa

Treatment of hypertension in patients with comorbidities: Results from the study of hypertensive prescribing practices (SHyPP)

Approximately 50 million people have hypertension. Many agents with differing efficacy, side effects, dosing schedules, and costs are available to treat hypertension. Joint National Committee (JNC) guidelines attempt to simplify this decision by recommending specific agents based on special considerations such as comorbidities. The objective of this study was to survey primary care physicians’ antihypertensive prescribing practices and their treatment recommendations for patients with comorbidities. A direct mail survey was sent to a national random sample of 500 office-based primary care internists, family practitioners, and general practitioners. There were no significant differences between initial treatment recommendations at the time of the survey and those recommended before the survey. However, there were several therapeutic classes whose reported utilization for specific comorbidities significantly changed over 18 months. Angiotensin converting enzyme (ACE) inhibitors reportedly increased in patients with congestive heart failure and diabetes. In addition, the reported use of selective β-blockers increased for patients with a history of myocardial infarction. Physicians did not follow JNC recommendations when initiating treatment in black patients, older patients, or those with mild renal failure. Younger physicians were more likely than older physicians to select agents consistent with guideline recommendations. Physicians did not adhere to JNC guidelines when initiating treatment in patients with comorbidities; however, more physicians are prescribing recommended agents today as compared to 18 months ago. Younger physicians were more likely to prescribe agents consistent with the guidelines. More direct efforts are needed to ensure awareness and compliance with these guidelines.

Hyperglycemic Crises in Urban Blacks

The hospital admission and mortality rates of patients with diabetic emergencies, such as diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar nonketotic syndrome (HHNS), are higher in black patients than in white patients with diabetes. However, there is limited data describing the precipitating events and response to treatment in black patients. Analysis of their clinical characteristics and response to medical therapy is needed to evaluate the impact of programs designed to reduce the development of these acute metabolic complications. A prospective evaluation was conducted of 144 consecutive patients with DKA and 23 patients with HHNS admitted to a large inner-city hospital between July 1993 and October 1994. In patients previously diagnosed as having diabetes, poor compliance with insulin therapy was the major precipitating cause for DKA (49%) and HHNS (42%). Alcohol or cocaine abuse was a contributing factor for noncompliance and was present in 35% and 13% of patients with DKA and in 44% and 9% of patients with HHNS, respectively. Newly diagnosed diabetes accounted for 17% of patients with DKA and HHNS. Obesity (body mass index > 28 kg/m2 [the weight in kilograms divided by the square of the height in meters]) was present in 29% of patients with DKA and in 17% with HHNS and was most common in patients with DKA who were newly diagnosed as having diabetes (56%). Patients were treated by residents, who used a low-dose insulin protocol with an algorithm for insulin adjustment in 88 of 144 patients with DKA and 14 of 23 patients with HHNS. Although there was no difference in mortality rates or time needed to correct hyperglycemia or ketoacidosis, the use of the protocol significantly reduced the risk of hypoglycemia (5%) compared with patients treated without a protocol (23%) (P < .01). In urban black patients, poor compliance with insulin therapy was the main precipitating cause of acute metabolic decompensation, and substance abuse was a significant contributing factor for noncompliance. Obesity is common in black patients with DKA; it was present in more than half of those with newly diagnosed diabetes. Improved patient education and better access to medical care might reduce the development of these hyperglycemic emergencies.

Effects of long-acting nifedipine on casual office blood pressure measurements, 24-hour ambulatory blood pressure profiles, exercise parameters and left ventricular mass and function in black patients with mild to moderate systemic hypertension

Thirty-nine black patients with mild to moderate hypertension were treated for 1 year with various long-acting preparations of nifedipine, during which time serial changes in 24-hour ambulatory blood pressure (BP), exercise performance, left ventricular (LV) mass index and LV systolic function were evaluated. Mean 24-hour ambulatory BP decreased from 156 ± 15 99 ± 8 to 125 ± 10 79 ± 6 mm Hg at 1 year (p <0.0001). LV mass index decreased from 130 ± 40 to 114 ± 39 g/m 2 at 6 weeks (p <0.005) and to 95 ± 32 at 1 year (p <0.0001). There was a significant reduction in septal and posterior wall thickness from 11.0 ± 2.0 to 9.3 ± 2.0 mm (p <0.0001) and from 10.9 ± 2.0 to 9.3 ± 2.0 mm (p <0.005), respectively. Cardiac index and fractional shortening changed insignificantly from 2.9 ± 0.7 to 2.9 ± 0.6 liters/min/m 2, and from 35 ± 5 to 36 ± 6%, respectively. At 1 year, using a modified Bruce protocol, exercise time increased from 691 ± 138 to 845 ± 183 seconds (p <0.05); peak exercise and 1 minute post-effort systolic BP decreased from 240 ± 26 to 200 ± 21 mm Hg and from 221 ± 27 to 169 ± 32 mm Hg (p <0.05), respectively. It is concluded that in the treatment of black patients with mild to moderate hypertension, the marked and sustained antihypertensive action of long-acting nifedipine documented by 24-hour ambulatory BP monitoring is associated with LV mass regression with no adverse effect on cardiac function together with a reduction in exercise systolic BP and a prolongation of exercise time.

An examination of factors influencing the diagnosis and treatment of black patients in the mental health system

The Civil Rights Movement, which began in the 1950s and lasted through the mid 1970s played a major role improving the quality of life for black Americans. Although much has changed since the 1950s the roots of racism are deep and change occurs slowly. Race exerts an overwhelming influence on popular ideology and medical thinking. Many researchers have speculated that a strong association exists between race and diagnosis. Understanding the sociocultural background of the patient would ald in the distinguishing culturally bound behavior from behavior that reflects actual psychopathology. This review examines the professional literature on racial and ethnic factors as they pertain to the diagnosis and treatment of black patients in the mental health system.

A Comparison of the Efficacy and Safety of a β-Blocker, a Calcium Channel Blocker, and a Converting Enzyme Inhibitor in Hypertensive Blacks

A double-blind, positively controlled, forced dose titration study comparing the efficacy and safety of atenolol, captopril, and verapamil sustained release as single agents in the treatment of black patients with mild to moderate hypertension (diastolic blood pressure, 95 to 114 mm Hg) was conducted. A total of 394 patients were randomized to one of the three therapies. Mean blood pressures during a 2- to 4-week placebo treatment period (baseline) ranged from 100.4 to 100.7 mm Hg diastolic and 151.7 to 152.5 mm Hg systolic for the three groups. Of the patients, 355 (of whom 345 had assessable data) completed the first treatment period, which consisted of therapy with either 50 mg/d of atenolol, 25 mg every 12 hours of captopril, or 240 mg/d of verapamil sustained release. During the second 4-week treatment period, which 319 patients completed (307 assessable), half of the patients had their antihypertensive medication increased and the other half continued the same dose. Goal blood pressure was defined as a supine diastolic pressure of less than 90 mm Hg or a 10-mm Hg or greater drop in supine diastolic blood pressure from pretreatment levels. Atenolol, captopril, and verapamil sustained release therapy was associated with goal blood pressure achievement during the first treatment period 55.1%, 43.8%, and 65.2% of the time, respectively, and during the second treatment period 59.6%, 57.1%, and 73.0% of the time. Side effects were minimal and comparable for all three drugs.

Notions about Culture in Understanding Black Psychopathology: Are We Trying to Raise the Dead?

Psychologists in a variety of mental health settings in South Africa have to deal with patients from black population groups. The literature on the diagnosis and treatment of black patients has not only been scarce, but has been further diluted by the fact that there is no formalized structure in training institutions in this area. Furthermore, the resistance to discussing the crucial issues pertaining to proper intervention strategies for this group of patients is remarkable. The author argues that cultural relativity is especially important in our pluralistic society and that failure to recognize cultural diversity is reflective of the cultural assumptions of the dominant minority culture. The author further proposes that such assumptions have race and class implications in that they reflect antiquated racial and class attitudes.

Considerations in the treatment of Black patients by White therapists.

Considerations in the treatment of Black patients by White therapists.