Ethnic/Racial Variations in Blood Pressure Awareness, Treatment, and Control (original) (raw)
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American Journal of Hypertension, 2022
BACKGROUND Controlled blood pressure can prevent or reduce adverse health outcomes. Social and structural determinants may contribute to the disparity that despite equivalent proportions on antihypertensive medication, non-Hispanic Black (Black) adults have lower blood pressure control and more cardiovascular events than non-Hispanic White (White) adults. METHODS Data from 2013 to 2018 National Health and Nutrition Examination Survey were pooled to assess control among Black and White adults by antihypertensive medication use and selected characteristics using the 2017 American College of Cardiology/American Heart Association (ACC/AHA) Blood Pressure Guideline definition (systolic blood pressure <130 mm Hg and diastolic blood pressure <80 mm Hg) among 4,739 adults. RESULTS Among those treated with antihypertensive medication, an estimated 34.9% of Black and 45.0% of White adults had controlled blood pressure. Control was lower for Black and White adults among most subgroups of...
Determinants of racial/ethnic differences in blood pressure management among hypertensive patients
BMC cardiovascular disorders, 2005
Prior literature has shown that racial/ethnic minorities with hypertension may receive less aggressive treatment for their high blood pressure. However, to date there are few data available regarding the confounders of racial/ethnic disparities in the intensity of hypertension treatment. We reviewed the medical records of 1,205 patients who had a minimum of two hypertension-related outpatient visits to 12 general internal medicine clinics during 7/1/01-6/30/02. Using logistic regression, we determined the odds of having therapy intensified by patient race/ethnicity after adjustment for clinical characteristics. Blacks (81.9%) and Whites (80.3%) were more likely than Latinos (71.5%) to have therapy intensified (P = 0.03). After adjustment for racial differences in the number of outpatient visits and presence of diabetes, there were no racial differences in rates of intensification. We found that racial/ethnic differences in therapy intensification were largely accounted for by differ...
Racial and Geographic Differences in Awareness, Treatment, and Control of Hypertension
Stroke, 2006
Background and Purpose— Stroke mortality is higher in the “Stroke Belt” and among blacks in the United States. Because hypertension is the leading risk factor for stroke, hypertension management (raising awareness, increasing treatment, and improving control) may reduce these disparities. Methods— Hypertension awareness, treatment, and control were measured in the REasons for Geographic And Racial Differences in Stroke study, a national population-based cohort of black and white participants >45 years of age. At the time of this report, 11 701 had been enrolled. Racial differences and geographic differences (between the Stroke Belt and other regions of the United States) were described. Results— Black participants were more aware than whites of their hypertension (odds ratio [OR], 1.31; 95% CI, 1.07 to 1.59) and more likely to be on treatment if aware of their diagnosis (OR, 1.69; 95% CI, 1.40 to 2.05), but among those treated for hypertension, they were less likely than whites t...
Racial Disparities in Hypertension Control: Not the Provider but Still a Problem
American Journal of Hypertension, 2010
To the Editor: We read with interest the Umscheid et al. article entitled "Racial Disparities in Hypertension Control, but Not Treatment Intensification, " which looked at the likelihood of hypertension treatment intensification for blacks vs. whites. 1 This study found hypertensive blacks more likely to have uncontrolled blood pressure, despite medication intensification based on guidelines from the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7). 2 Although the authors collected data on the types of comorbidities, they did not
…, 2007
Historically, blood pressure control in Hispanics has been considerably less than that of non-Hispanic whites and blacks. We compared determinants of blood pressure control among Hispanic white, Hispanic black, non-Hispanic white, and non-Hispanic black participants (Nϭ32 642) during follow-up in a randomized, practice-based, activecontrolled trial. Hispanic blacks and whites represented 3% and 16% of the cohort, respectively; 33% were non-Hispanic black and 48% were non-Hispanic white. Hispanics were less likely to be controlled (Ͻ140/90 mm Hg) at enrollment, but within 6 to 12 months of follow-up, Hispanics had a greater proportion Ͻ140/90 mm Hg compared with non-Hispanics. At 4 years of follow-up, blood pressure was controlled in 72% of Hispanic whites, 69% of Hispanic blacks, 67% of non-Hispanic whites, and 59% of non-Hispanic blacks. Compared with non-Hispanic whites, Hispanic whites had a 20% greater odds of achieving BP control by 2 years of follow-up (odds ratio: 1.20; 95% CI: 1.10 to 1.31) after controlling for demographic variables and comorbidities, Hispanic blacks had a similar odds of achieving BP control (odds ratio: 1.04; 95% CI: 0.86 to 1.25), and non-Hispanic blacks had a 27% lower odds (odds ratio: 0.73; 95% CI: 0.69 to 0.78). We conclude that in all patients high levels of blood pressure control can be achieved with commonly available medications and that Hispanic ethnicity is not associated with inferior control in the setting of a clinical trial in which hypertensive patients had equal access to medical care, and medication was provided at no cost. (Hypertension. 2007;50:854-861.) Key Words: hypertension Ⅲ Hispanic Ⅲ ethnicity Ⅲ race Ⅲ clinical trials Ⅲ blood pressure control I n the United States, there are racial and ethnic differences in the prevalence, awareness, treatment, and control of hypertension. Compared with non-Hispanic whites, Mexican Americans had a similar age-adjusted prevalence of hypertension (Ϸ28%) in data collected in 2003-2004 for the National Health and Nutrition Examination Survey (NHANES), a national population-based study. 1 In the same study, non-Hispanic blacks had the highest age-adjusted prevalence of hypertension (39%). Between NHANES II (1976-1980) and NHANES III (1988-1991), there were substantial improvements in hypertension awareness, treatment, and control in both non-Hispanic whites and blacks. 2 In contrast, between the Hispanic Health and Nutrition Examination Survey (1982-1984)
Research Needs to Improve Hypertension Treatment and Control in African Americans
Hypertension (Dallas, Tex. : 1979), 2016
T his report presents findings of an ad hoc working group assembled by the National Heart, Lung, and Blood Institute (NHLBI) to assess research needs to improve prevention, treatment, and control of hypertension among African Americans. Non-Hispanic Blacks (African American and Black will be used for US and international studies, respectively) tend to have an earlier onset, higher prevalence, and disproportionately high risk of complications for hypertension compared with non-Hispanic Whites and Mexican Americans. 1 Surveillance and Measurement of Blood Pressure Surveys identify substantial variation in mean blood pressure (BP) among populations of African origin. 2 In high-income countries, including the United States, mean BP and prevalence of hypertension are higher in adults self-described, 3-6 observer reported, 7,8 or otherwise identified 9,10 as being black or having darker skin color. 11 However, the relationship between African origin and BP is absent or only minimally apparent in reports from middle-income countries. 12-14 Research to clarify reasons for this variability may contribute to understanding of hypertension-related racial disparities in the United States. In US National Health and Nutrition Examination Survey (NHANES) reports, crude and age-adjusted prevalence of hypertension (systolic BP [SBP] ≥140 mm Hg, diastolic BP ≥90 mm Hg, or taking antihypertensive medication) in adults has remained fairly constant at ≈30% since 1999 to 2000. 3,4 The corresponding prevalence estimate for African Americans is ≈40% and has also remained reasonably stable. In African Americans, hypertension awareness and treatment rates are higher but control rates lower compared with non-Hispanic Whites (85.7% versus 82.7% for awareness, 77.4% versus 76.7% for treatment, and 49.5% versus 53.9% for control in NHANES 2011-2012). 4 The lower prevalence of BP control is present despite use of more BP-lowering medications, including thiazide diuretics. 15 This contrasts with clinical trial experience, where differences in BP control rates by race/ethnicity are modest or absent, particularly during chlorthalidone-based treatment. 16 High levels of BP control, including in African
The Role of Hypertension in Race-Ethnic Disparities in Cardiovascular Disease
Current Cardiovascular Risk Reports, 2015
Race-ethnic disparities in cardiovascular disease (CVD) have persisted in the USA over the past few decades. Hypertension (HTN) is a significant contributor to CVD, including coronary heart disease, stroke, end-stage kidney disease and overall mortality and race-ethnic disparities in longevity. Additionally, both non-Hispanic blacks (NHBs) and Hispanic adults have been known to have higher prevalence of poorly controlled blood pressure compared to non-Hispanic whites (NHWs). Addressing these disparities has been a focus of programs such as the Million Hearts initiative. This review will provide an update of available data on HTN in various race-ethnic groups, including awareness, treatment, and control and note the recent progress in HTN control across all race/ethnic groups. We will also discuss the recent 2014 U.S. HTN guideline that has led to debate regarding the potential impact of BP goals in older persons on worsening CVD disparities, with disproportionate effects on women and NHBs.
Ethnicity & disease, 2012
This study compared the hypertension prevalence, awareness, treatment and control in Chicago, Illinois and Detroit, Michigan to that of the general United States population (aged > or = 25 years) for the period 2001-2003. We examined whether and how much 1) urban populations have less favorable hypertension-related outcomes and 2) the rates of racial/ethnic minorities lag behind those of Whites in order to determine if the national data understate the magnitude of hypertension-related outcomes and racial/ethnic disparities in two large cities in the Midwestern region of the United States and perhaps others. Unstandardized and standardized hypertension-related outcome rates were estimated. The hypertension-related outcomes among Chicago and Detroit residents lag behind the United States by 8%-14% and 10%-18% points, respectively. Additionally, this study highlights the complexity of the racial/ethnic differences in hypertension-related outcomes, where within each population, Black...
High blood pressure in Hispanics in the United States
Current Opinion in Cardiology, 2019
Purpose of review To provide an overview of the available data on the prevalence of hypertension (HTN) in various groups and segments of the Hispanic population; prevalence of awareness, treatment and control of HTN among Hispanics; and HTN-related disparities, through disproportionate effects on the Hispanic elderly, women, and young adults. Recent findings Data on HTN in Hispanics has been lacking or aggregated and frequently not inclusive of certain groups of Hispanics but the available data do show a pattern of more prevalent HTN and HTN disparities among Hispanics compared with non-Hispanic whites. Hispanic adults have some of the highest prevalence of poorly controlled blood pressure compared with any other race-ethnic group in the United States. Further, the impact of the most recent iteration of the HTN guidelines among all segments of the Hispanic population has not been well studied.
Ethnicity & disease, 2005
Hypertension is a major contributor to ethnic disparities in cardiovascular disease, especially among low-income African Americans in the southeast United States. To assess differences between African Americans and Caucasians in the prevalence, treatment, and control of hypertension in outpatient clinics for under-served patients in South Carolina. A random sample of outpatient charts on 7795 adults was abstracted from 31 primary care clinics providing health care for approximately 180,000 medically under-served patients. Variables included visit dates, blood pressures (BP), diagnosis of hypertension, and medications. Data were abstracted from outpatient medical records on 4694 African Americans (1483 men, 3195 women, 16 gender unknown, age 46.8 +/- 0.3 years) and 2540 Caucasians (1031 men, 1492 women, 17 gender unknown, age 47.7 +/- 0.4 years). The prevalence of hypertension was greater in African Americans than Caucasians (47.6% vs 31.0%, P < .001). The percentages of hypertens...