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April 3, 2026Epidemiology

Applying the Target Study Conceptual Model to Measure Racial and Ethnic Disparities in Hypertension Treatment Intensification

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Why the study?

To demonstrate the application of the Target Study conceptual model to measure racial and ethnic disparities in hypertension treatment intensification consistent with the Institute of Medicine definition.

Are there racial disparities in hypertension treatment intensification between Black and White patients after adjusting for allowable covariates?

Population

Adults with hypertension seen at primary care clinics within a Mid-Atlantic healthcare system

Comparison

Black vs White patients

Design

Target study emulation using electronic medical record data

Key result

Black patients had a lower probability of hypertension treatment intensification than White patients after covariate adjustment (2020 adjusted disparity -3 percentage points; 95% CI -4% to -1%).

Authors

AMAster MecheRBRomsai T. BoonyasaiYHYea‐Jen Hsu

Discussion

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Overview

Clinicians should scrutinize hypertension intensification for racial bias; confirms disparities persist despite adjustment for clinical and access factors.

Key Points

  • The aim is to measure racial and ethnic disparities in hypertension treatment intensification, specifically between Black and White patients.
  • Applied a conceptual model called the Target Study from 2018 to 2022.
  • Used electronic medical record data from a large healthcare system.
  • Emulated the specified target study with an appropriate study design.
  • Utilized inverse probability weighting to balance allowable covariates.
  • Black patients showed a higher percentage of treatment intensification compared to White patients in unadjusted analyses.
  • Annual differences in treatment intensification ranged from 2 to 4 percentage points.
  • Adjusted analyses revealed Black patients had lower percentages of treatment intensification by 3–4 percentage points each year.

Study Design

Type

Observational

Multicenter

Yes

Structured PICO

Are there racial disparities in hypertension treatment intensification between Black and White patients after adjusting for allowable covariates?

P
Population
Adults with hypertension seen at primary care clinics within a large healthcare system in the Mid-Atlantic region
I
Intervention
Black race
C
Comparator
White race
O
Outcome
Probability of treatment intensification

Main Result

Effect estimate: Adjusted difference -3 percentage points (for 2020) (95% CI -4%, -1%)

Applying the Target Study conceptual model with inverse probability weighting reveals that Black patients with hypertension experience consistently lower rates of treatment intensification compared to White patients after adjusting for clinical needs and access factors.

Cite This Study

Meche et al. (2026) conducted an observational in Hypertension. Black patients vs. White patients was evaluated on Probability of treatment intensification (Adjusted difference -3 percentage points (for 2020), 95% CI -4%, -1%). Black patients had a lower probability of hypertension treatment intensification than White patients after covariate adjustment (2020 adjusted disparity -3 percentage points; 95% CI -4% to -1%).

synapsesocial.com/papers/69cf5ced5a333a821460a738https://doi.org/10.1097/ede.0000000000001964
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