title: Diuretic use in black patients with uncontrolled hypertension.
abstract: BACKGROUND
  Highly publicized recommendations favor the use of diuretics as a first-line or add-on agent in the management of hypertension, particularly among black patients and patients with resistant hypertension. Failure to follow such guidelines might contribute to high rates of uncontrolled hypertension. This study assessed diuretic prescribing patterns in a sample of black patients with uncontrolled hypertension who were identified from a population of home care recipients.
  
  
  METHODS
  The study was conducted in an urban home health organization. Participants were black, aged 21 to 80 years, and had a diagnosis of hypertension. Participants with uncontrolled hypertension were identified, and in-home interviewers collected information on prescribed antihypertensive medications.
  
  
  RESULTS
  Of 658 participants, 5.5% were not prescribed any antihypertensives, and only 46% were prescribed a diuretic. Participants who were not taking a diuretic were taking fewer antihypertensive medications (1.7 vs. 2.9; P < 0.0001), had a higher mean diastolic blood pressure (89.2 vs. 85.5; P = 0.0005), and were more likely to have a systolic blood pressure ≥160mm Hg (57.6% vs. 49.0%; P = 0.04). The adjusted mean systolic and diastolic blood pressures were 5 and 4mm Hg lower, respectively, in patients who were taking a diuretic.
  
  
  CONCLUSIONS
  In this sample of black patients with uncontrolled hypertension, despite wide publicizing of the recommendations for use of diuretics, a majority are still not receiving a diuretic. This important issue merits continued attention.
authors: Department of Public Health, Weill Cornell Medical College, New York, NY, USA. LIG2002@med.cornell.edu
authors: Linda M
authors: LM
authors: Gerber
authors: Samuel J
authors: SJ
authors: Mann
authors: Margaret V
authors: MV
authors: McDonald
authors: Ya-Lin
authors: YL
authors: Chiu
authors: Sridevi
authors: S
authors: Sridharan
authors: Penny H
authors: PH
authors: Feldman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D044383:Black People / Q000208:ethnology*; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D004232:Diuretics / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D006306:Health Surveys; D018574:Home Care Agencies / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000208:ethnology* / Q000503:physiopathology; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D016896:Treatment Outcome; D014481:United States; D001741:Black or African American
chemical_list: D000959:Antihypertensive Agents; D004232:Diuretics
references: J Clin Hypertens (Greenwich). 2006 Dec;8(12):865-72
references: 17170612
references: J Gen Intern Med. 2008 May;23(5):543-50
references: 18219539
references: Lancet. 1999 Jun 12;353(9169):2008-13
references: 10376615
references: Arch Intern Med. 2003 Mar 10;163(5):525-41
references: 12622600
references: J Clin Hypertens (Greenwich). 2007 May;9(5):345-54
references: 17485970
references: BMJ. 2008 May 17;336(7653):1121-3
references: 18480116
references: Hypertension. 2008 Jun;51(6):1403-19
references: 18391085
references: Med Care. 2005 Jun;43(6):607-15
references: 15908856
references: Am J Hypertens. 2003 Nov;16(11 Pt 1):925-30
references: 14573330
references: JAMA. 2005 Apr 6;293(13):1595-608
references: 15811979
references: Curr Med Res Opin. 1996;13(7):409-15
references: 8862940
references: J Am Coll Cardiol. 2003 Apr 2;41(7):1148-55
references: 12679215
references: Circulation. 2011 Feb 1;123(4):e18-e209
references: 21160056
references: Am J Cardiol. 1985 Dec 6;56(16):81H-85H
references: 2933951
references: N Engl J Med. 2008 Dec 4;359(23):2417-28
references: 19052124
references: J Am Coll Cardiol. 2011 Feb 1;57(5):590-600
references: 21272751
references: Curr Opin Cardiol. 2010 Jul;25(4):355-65
references: 20520537
references: N Engl J Med. 1992 Aug 20;327(8):543-7
references: 1635569
references: Circ Cardiovasc Qual Outcomes. 2009 May;2(3):241-8
references: 20031844
references: J Clin Hypertens (Greenwich). 2010 Mar;12(3):187-92
references: 20433532
references: JAMA. 2002 Dec 18;288(23):2981-97
references: 12479763
references: Arch Intern Med. 1989 Dec;149(12):2677-81
references: 2596940
references: Arch Intern Med. 2010 May 24;170(10):851-8
references: 20498411