title: Effect of treatment and adherence on ethnic differences in blood pressure control among adults with hypertension.
abstract: We evaluated whether hypertension control differs by ethnicity after accounting for patient characteristics, treatment, and adherence to treatment using the third National Health and Nutrition Examination Survey (US population estimate, 42,511,379). Outcome measures were prescribed treatment, treatment adherence, hypertension control (blood pressure [BP]<140/90 mm Hg). Multivariate logistic regression was performed with non-Hispanic whites (NHW) as the comparison group. Non-Hispanic blacks (NHB) were more likely to report medication prescription (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.1-2.5) and being advised to restrict salt (OR 1.5, CI: 1.2-2.0). Among those advised, NHB were more likely to report salt restriction (OR 1.5, CI: 1.1-2.1) and weight-loss attempts (OR 1.7, CI: 1.3-2.3). Among persons advised to follow exercise, alcohol restriction, smoking cessation, tension reduction, or diet modification, NHB (OR 2.2, CI: 1.6-3.0) and Mexican Americans (OR 2.0, CI: 1.1-3.9) were more likely to report adherence. The likelihood of uncontrolled hypertension was higher in NHB (OR 1.4, CI: 1.1-1.7) and Mexican Americans (OR 1.5, CI 1.1-2.0) despite medication adherence. Even after adjustment for treatment and adherence, substantial ethnic differences in hypertension control were found. Initiating treatment, while crucial, is not sufficient and future guidelines should emphasize aggressive treatment escalation to achieve hypertension control.
authors.affiliation: Department of Medicine, New York University School of Medicine and the VA New York Harbor Healthcare System, New York City, USA. sundar.natarajan@med.nyu.edu
authors.forename: Sundar
authors.initials: S
authors.lastname: Natarajan
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Santa Ana
authors.forename: Youlian
authors.initials: Y
authors.lastname: Liao
authors.forename: Stuart R
authors.initials: SR
authors.lastname: Lipsitz
authors.forename: Daniel L
authors.initials: DL
authors.lastname: McGee
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D015992:Body Mass Index; D004039:Diet, Sodium-Restricted; D005260:Female; D015438:Health Behavior / Q000208:ethnology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology / Q000208:ethnology* / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000208:ethnology*; D014481:United States / Q000453:epidemiology; D015431:Weight Loss; D055815:Young Adult
chemical_list: D000959:Antihypertensive Agents