title: Generic medications and blood pressure control in diabetic hypertensive subjects: results from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study.
abstract: OBJECTIVE
  To investigate temporal improvements in blood pressure (BP) control in subjects with diabetes and policy changes regarding generic antihypertensives.
  
  
  METHODS
  In a cross-sectional study we used logistic regression models to investigate the temporal relationship between access to generic antihypertensive medications and BP control (<130/80 mmHg) in 5,375 subjects (mean age, 66 ± 9 years; 61% African American) with diabetes and hypertension (HTN) enrolled in the national Results from the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort study between 2003 and 2007. At enrollment, BP was measured and medications in the home determined by medication label review by a trained professional. Generic antihypertensive medication status was ascertained from the U.S. Food and Drug Administration.
  
  
  RESULTS
  The percentage of subjects accessing generically available antihypertensive medications increased significantly from 66% in 2003 to 81% in 2007 (P < 0.0001), and the odds of achieving a BP <130/80 mmHg in 2007 was 66% higher (odds ratio 1.66 [95% CI 1.30-2.10]) than in 2003. Nevertheless, <50% of participants achieved this goal. African American race, male sex, limited income, and medication nonadherence were significant predictors of inadequate BP control. There was no significant relationship between access to generic antihypertensives and BP control when other demographic factors were included in the model (0.98 [0.96-1.00]).
  
  
  CONCLUSIONS
  Among African American and white subjects with HTN and diabetes, BP control remained inadequate relative to published guidelines, and racial disparities persisted. Although access to generic antihypertensives increased, this was not independently associated with improved BP control, suggesting that poor BP control is multifactorial.
authors.affiliation: Departments of Family Medicine and Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, USA. cummingsd@ecu.edu
authors.forename: Doyle M
authors.initials: DM
authors.lastname: Cummings
authors.forename: Abraham J
authors.initials: AJ
authors.lastname: Letter
authors.forename: George
authors.initials: G
authors.lastname: Howard
authors.forename: Virginia J
authors.initials: VJ
authors.lastname: Howard
authors.forename: Monika M
authors.initials: MM
authors.lastname: Safford
authors.forename: Valerie
authors.initials: V
authors.lastname: Prince
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged
chemical_list: D000959:Antihypertensive Agents