Racial and geographic differences in awareness, treatment, and control of hypertension: the REasons for Geographic And Racial Differences in Stroke study.
OBJECTIVE
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 to have their blood pressure controlled (OR, 0.73; 95% CI, 0.64 to 0.83). There was no evidence of a difference between the Stroke Belt and other regions in awareness of hypertension (OR, 0.95; 95% CI, 0.79 to 1.14), but there was a trend for better treatment (OR, 1.15; 95% CI, 0.97 to 1.37) and control (OR, 1.11; 95% CI, 0.98 to 1.30) in the Stroke Belt region.


CONCLUSIONS
These findings suggest that interventions to improve blood pressure control among blacks are promising to reduce the racial disparity in stroke mortality. The lack of substantial geographic differences in hypertension awareness and the trend toward better treatment and control in the Stroke Belt suggest that differences in hypertension management may not be a major contributor to the geographic disparity in stroke mortality.
Howard
George
G
Department of Biostatistics, School of Public Health, University of Alabama, Birmingham, AL 35294, USA. ghoward@uab.edu
Prineas
Ron
R
Moy
Claudia
C
Cushman
Mary
M
Kellum
Martha
M
Temple
Ella
E
Graham
Andra
A
Howard
Virginia
V
D001741:Black or African American; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology / Q000208:ethnology / Q000628:therapy; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000453:epidemiology / Q000208:ethnology / Q000209:etiology / Q000517:prevention & control; D014481:United States / Q000453:epidemiology; D044465:White People