Racial/ethnic disparities in medication use among veterans with hypertension and dementia: a national cohort study.
BACKGROUND
Hypertension and comorbid dementia are common illnesses affecting older adults disproportionally. Medication adherence is vital in achieving therapeutic outcomes. Use of antihypertensive and dementia medications may vary by race/ethnicity and has not been well explored.


OBJECTIVE
To evaluate the utilization of antihypertensive and dementia drugs and adherence in a national cohort of veterans aged 65 years or older with a diagnosis of both hypertension and dementia across different racial/ethnic groups.


METHODS
This was a retrospective cohort study that used 2 national databases of the Veterans Health Administration to estimate medication utilization and adherence rates among whites, African Americans, and Hispanics from 2000 to 2005. A medication possession ratio of 0.8 or greater defined adherence. The association between race/ethnicity and adherence was analyzed using multivariate logistic regression analysis.


RESULTS
A total of 56,561 patients (70.5% white, 15.6% African American, 6.6% Hispanic) aged 65 years or older had diagnoses of dementia and hypertension. African Americans were less likely than whites to receive angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), beta-blockers, acetylcholinesterase inhibitors, and memantine (p < 0.05). Hispanics were more likely than whites to be prescribed an ACE inhibitor and less likely to be prescribed an ARB, beta-blocker, nondihydropyridine calcium-channel blocker (CCB), loop diuretic, alpha-agonist, or potassium-sparing diuretic (PSD) (p < 0.05). Medication adherence was significantly lower in African Americans than whites in all classes except for ARBs, loop diuretics, and PSDs (p < 0.05). Being Hispanic was associated with significantly lower adherence rates than whites for dihydropyridine CCBs and acetylcholinesterase inhibitors (p < 0.05).


CONCLUSIONS
Racial/ethnic differences exist in antihypertensive and dementia medication use in a cohort of older adults with hypertension and dementia. Adherence rates for a number of antihypertensive and dementia drugs are lower for minorities compared with whites. Healthcare providers should make special efforts to improve medication adherence among minorities.
Poon
Ivy
I
Pharmacy Practice Department, Texas Southern University, Houston, TX 77004, USA. chui_io@tsu.edu
Lal
Lincy S
LS
Ford
Marvella E
ME
Braun
Ursula K
UK
D001741:Black or African American; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D015331:Cohort Studies; D003704:Dementia / Q000150:complications* / Q000188:drug therapy / Q000208:ethnology; D004363:Drug Utilization; D005006:Ethnicity; D005260:Female; D054625:Healthcare Disparities; D006630:Hispanic or Latino; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy / Q000208:ethnology; D008297:Male; D055118:Medication Adherence / Q000208:ethnology*; D008559:Memantine / Q000627:therapeutic use; D015995:Prevalence; D014728:Veterans; D044465:White People; D016903:Drug Monitoring
D000959:Antihypertensive Agents; D002800:Cholinesterase Inhibitors; D008559:Memantine