title: Racial/ethnic disparities in medication use among veterans with hypertension and dementia: a national cohort study.
abstract: 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.
authors.affiliation: Pharmacy Practice Department, Texas Southern University, Houston, TX 77004, USA. chui_io@tsu.edu
authors.forename: Ivy
authors.initials: I
authors.lastname: Poon
authors.forename: Lincy S
authors.initials: LS
authors.lastname: Lal
authors.forename: Marvella E
authors.initials: ME
authors.lastname: Ford
authors.forename: Ursula K
authors.initials: UK
authors.lastname: Braun
mesh_terms: 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
chemical_list: D000959:Antihypertensive Agents; D002800:Cholinesterase Inhibitors; D008559:Memantine