title: Racial/Ethnic differences in medication uptake and clinical outcomes among hospitalized cardiovascular patients with hypertension and diabetes.
abstract: BACKGROUND
  In the United States, hypertension and diabetes are more common among blacks and Hispanics than among others; the comorbidity is associated with worse clinical outcomes than each condition alone. Racial/ethnic differences in outcomes may be related to differential uptake of antihypertensive therapies, but data to evaluate this in real-world settings are limited. We aimed to determine the association between race/ethnicity and odds of rehospitalization or death, accounting for medication prescription, among a cohort of patients with hypertension and diabetes hospitalized for cardiovascular disease.
  
  
  METHODS
  This was a 1-year prospective study of individuals that participated in a National Heart, Lung, and Blood Institute clinical outcomes study. Clinical/medication data and outcomes (rehospitalization and death at 30 days and at 1 year) were documented by electronic medical record, National Death Index, and standardized mail survey. Logistic regression was used to evaluate associations between race/ethnicity and outcomes adjusted for type of antihypertensive medication, demographics, and comorbidity.
  
  
  RESULTS
  Participants (n = 1,126) were 14% black, 28% Hispanic, and 58% white/other. A total of 611 (54%) participants were rehospitalized at 1 year. Predictors of rehospitalization at 1 year included Hispanic ethnicity, diuretic prescription, lack of health insurance, peripheral vascular disease, and heart failure (P < 0.05). Race/ethnicity was not associated with rehospitalization at 30 days or death at 30 days or at 1 year. Increased odds of rehospitalization at 1 year among Hispanics remained significant after multivariable adjustment (odds ratio = 1.6; 95% confidence interval = 1.2-2.1).
  
  
  CONCLUSIONS
  In this study of hospitalized hypertension patients with diabetes, Hispanics had higher odds of rehospitalization than whites/others at 1 year but not at 30 days, and this was not explained by type of antihypertension medication prescribed.
authors.affiliation: Department of Medicine, Columbia University Medical Center, New York;
authors.forename: Heidi
authors.initials: H
authors.lastname: Mochari-Greenberger
authors.affiliation: Department of Medicine, Columbia University Medical Center, New York; New York-Presbyterian Hospital, New York . ljm10@columbia.edu.
authors.forename: Lori
authors.initials: L
authors.lastname: Mosca
mesh_terms: D001741:Black or African American / Q000523:psychology*; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D016009:Chi-Square Distribution; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000208:ethnology* / Q000401:mortality; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D006630:Hispanic or Latino / Q000523:psychology*; D006760:Hospitalization; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000208:ethnology* / Q000401:mortality / Q000503:physiopathology / Q000523:psychology; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence / Q000208:ethnology*; D008875:Middle Aged; D016017:Odds Ratio; D010359:Patient Readmission; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D044465:White People / Q000523:psychology*
chemical_list: D000959:Antihypertensive Agents
keywords: blood pressure; disparities; hypertension; race and ethnicity; rehospitalization.