title: Impact of race on cumulative exposure to antihypertensive medications in dialysis.
abstract: BACKGROUND
  Racial minorities typically have less exposure than non-minorities to antihypertensive medications across an array of cardiovascular conditions in the general population. However, cumulative exposure has not been investigated in dialysis patients.
  
  
  METHODS
  In a longitudinal analysis of 38,381 hypertensive dialysis patients, prescription drug data from Medicaid was linked to Medicare data contained in United States Renal Data System core data, creating a national cohort of dialysis patients dually eligible for Medicare and Medicaid services. The proportion of days covered (PDC) was calculated to determine cumulative exposure to angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), β-blockers, and calcium-channel blockers (CCDs). The factors associated with use of these medications were modeled through weighted linear regression, with derivation of the adjusted odds ratios (AORs) for exposure.
  
  
  RESULTS
  Relative to non-Hispanic Caucasians, African-American, Hispanic, or Other race/ethnicity were significantly associated with less exposure to β-blockers (AOR 0.56-0.69, P < 0.001 in each case) and CCBs (AOR 0.84-0.85, P < 0.001 in each case); African-American race and Hispanic ethnicity had AORs of 0.78 and 0.73 for ACEIs and ARBs, respectively (P < 0.001 in both cases). Collectively, the odds of exposure to each class of medication for minorities was about three-quarters of that for Caucasians.
  
  
  CONCLUSIONS
  Given that dually Medicare-and-Medicaid-eligible dialysis patients have insurance coverage for prescription medications as well as regular contact with health care providers, differences by race in exposure to antihypertensive medications should with time be minimal among patients who are candidates for these drugs. The causes of differences by race in exposure to antihypertensive medications over the course of time should be further examined.
authors: Department of Medicine, Division of Nephrology and Hypertension, University of Kansas School of Medicine, Kansas City, KS, USA.
authors: James B
authors: JB
authors: Wetmore
authors: Jonathan D
authors: JD
authors: Mahnken
authors: Sally K
authors: SK
authors: Rigler
authors: Edward F
authors: EF
authors: Ellerbeck
authors: Purna
authors: P
authors: Mukhopadhyay
authors: Qingjiang
authors: Q
authors: Hou
authors: Theresa I
authors: TI
authors: Shireman
mesh_terms: D001741:Black or African American; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006630:Hispanic or Latino; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology*; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000628:therapy; D008137:Longitudinal Studies; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D055656:Prescriptions / Q000706:statistics & numerical data; D044469:Racial Groups / Q000706:statistics & numerical data*; D006435:Renal Dialysis; D012189:Retrospective Studies; D014481:United States; D044465:White People
chemical_list: D000959:Antihypertensive Agents
references: Nephrol Dial Transplant. 2006 Aug;21(8):2202-9
references: 16522661
references: Lancet. 2003 Jul 5;362(9377):7-13
references: 12853193
references: Nephrol Dial Transplant. 2009 Sep;24(9):2809-16
references: 19443648
references: Am J Kidney Dis. 2009 Mar;53(3):457-66
references: 19022545
references: Med Care. 2011 May;49(5):489-95
references: 21422958
references: Circulation. 2005 Mar 15;111(10):1225-32
references: 15769762
references: Am J Cardiovasc Drugs. 2010;10(2):109-14
references: 20334448
references: Am J Kidney Dis. 2007 Feb;49(2):276-83
references: 17261430
references: N Engl J Med. 2000 Jan 20;342(3):145-53
references: 10639539
references: J Natl Med Assoc. 2003 Jan;95(1):17-27
references: 12656446
references: Am Heart J. 2010 Mar;159(3):377-84
references: 20211298
references: Ethn Dis. 2005 Winter;15(1):25-32
references: 15720046
references: Ann Pharmacother. 2009 Feb;43(2):185-93
references: 19193586
references: Clin J Am Soc Nephrol. 2010 Apr;5(4):623-30
references: 20133488
references: Kidney Int. 2002 Jun;61(6):2157-64
references: 12028456
references: Nephrol Dial Transplant. 2010 Jan;25(1):198-205
references: 19736241
references: JAMA. 2002 Jul 24-31;288(4):455-61
references: 12132975
references: Kidney Int. 2010 Jan;77(2):141-51
references: 19907414
references: Am J Cardiol. 2010 Apr 1;105(7):1019-23
references: 20346324
references: Kidney Int. 2002 Nov;62(5):1784-90
references: 12371980
references: J Manag Care Pharm. 2009 Nov-Dec;15(9):728-40
references: 19954264
references: Pharmacoepidemiol Drug Saf. 2010 Aug;19(8):834-42
references: 20681002
references: JAMA. 2002 Sep 25;288(12):1491-8
references: 12243636
references: Circ Cardiovasc Qual Outcomes. 2011 Jul;4(4):467-76
references: 21772003
references: Am J Kidney Dis. 2011 Jul;58(1):73-83
references: 21621889
references: Am Heart J. 2007 May;153(5):785-91
references: 17452154
references: Pharmacoepidemiol Drug Saf. 2010 Apr;19(4):384-92
references: 20140890
references: Nat Clin Pract Nephrol. 2007 Sep;3(9):493-506
references: 17717562
references: Curr Hypertens Rep. 2010 Oct;12(5):356-63
references: 20821077
references: Lancet. 2003 Sep 6;362(9386):767-71
references: 13678869
references: Clin J Am Soc Nephrol. 2009 May;4(5):950-6
references: 19389825
references: J Clin Hypertens (Greenwich). 2005 Aug;7(8):445-54
references: 16103755
references: N Engl J Med. 2003 Nov 13;349(20):1893-906
references: 14610160
references: Nephrol Dial Transplant. 2004 Jul;19(7):1842-8
references: 15128886
references: N Engl J Med. 2001 Sep 20;345(12):861-9
references: 11565518
references: Am J Physiol Heart Circ Physiol. 2009 Jan;296(1):H140-51
references: 18978191
references: Lancet. 2005 Sep 10-16;366(9489):895-906
references: 16154016
references: J Am Soc Nephrol. 2005 Jan;16(1):269-77
references: 15563568
references: N Engl J Med. 1998 Mar 5;338(10):645-52
references: 9486993
references: ANNA J. 1999 Jun;26(3):307-16; discussion 317, 335
references: 10633602
references: J Am Soc Nephrol. 2011 Apr;22(4):743-51
references: 21372209
references: J Pharm Pharmacol. 2009 Sep;61(9):1233-41
references: 19703374
references: Am J Cardiol. 2007 Oct 1;100(7):1061-7
references: 17884362
references: Am J Kidney Dis. 2008 Oct;52(4):753-60
references: 18514986
references: Kidney Int. 2004 Mar;65(3):1017-25
references: 14871422
references: JAMA. 2004 Dec 15;292(23):2849-59
references: 15598916
references: Lancet. 2001 May 5;357(9266):1385-90
references: 11356434
references: Lancet. 1999 Jun 12;353(9169):2001-7
references: 10376614
references: Am J Kidney Dis. 2003 Dec;42(6):1260-9
references: 14655199
references: Kidney Int. 2011 Nov;80(9):978-985
references: 21775975
references: JAMA. 2005 Oct 12;294(14):1794-8
references: 16219883
references: Arch Intern Med. 2004 Dec 13-27;164(22):2465-71
references: 15596637
references: Prev Med. 2006 Apr;42(4):313-5
references: 16405983
references: J Am Soc Nephrol. 2008 Jul;19(7):1271-5
references: 18524999
references: N Engl J Med. 2008 Dec 4;359(23):2417-28
references: 19052124