Understanding racial disparities in hypertension control: intensity of hypertension medication treatment in the REGARDS study.
OBJECTIVE
African Americans (AA) suffer excess hypertension-related health outcomes and their blood pressures (BPs) are widely reported to be less controlled than European Americans (EA). Intensity of hypertension treatment may play a role. We examined whether AA with treated hypertension received less-intense medication regimens than EA, as reflected in the number of antihypertensive medication classes.


METHODS
Cross-sectional observation of baseline information from the REasons for Geographic And Racial Differences in Stroke cohort. Participants were recruited by telephone in 2003-2005, completed a telephone survey, and had BP measured and medications recorded during an in-home visit. The study's outcome was the number of classes of antihypertensive medications.


METHODS
U.S. national cohort study with oversampling from high stroke mortality regions. Participants were self-identified AA or EA, > or =45 years old, living in the community, and balanced on AA race and sex by design.


METHODS
8960 individuals with treated hypertension.


RESULTS
Mean age was 68.0 +/- 8.6 years. AA were poorer and less educated than EA, and had worse BP control (63.5% BP < 140/ 90 mm Hg for AA, 74.0% for EA, P < .01), yet they were on more classes of BP medication (24.1% on > or =3 classes, vs. 16.9%, P < .01). AA were taking an average of 0.138 more antihypertensive medication classes than otherwise similar EA (P < .01). More intense treatment persisted across all age, sex, education, income and BP groups.


CONCLUSIONS
AA were more intensely treated for hypertension than EA. Further study to identify action strategies to eliminate racial differences in hypertension outcomes is warranted.
Safford
Monika M
MM
University of Alabama at Birmingham, Birmingham, USA. msafford@uab.edu
Halanych
Jewell H
JH
Lewis
Cora E
CE
Levine
Deborah
D
Houser
Shannon
S
Howard
George
G
D001741:Black or African American; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D054625:Healthcare Disparities; D006792:House Calls; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D014481:United States