title: Race-ethnicity on blood pressure control after ischemic stroke: a prospective cohort study.
abstract: Disparities in health care access and socioeconomic status (SES) have been associated with racial-ethnic differences in blood pressure (BP) control. We examined post-ischemic stroke BP in a multiethnic cohort with good health care access. We included all hypertensive patients (n = 2972) from a randomized quality improvement trial on secondary stroke prevention, conducted in 14 Kaiser Permanente hospitals in Northern California from 2004-2006 (QUISP). Average age 73.2 ± 12.2 years; 52% female, 66% non-Hispanic white, 14% African-American, 11% Asian, 8% Hispanic, and 1% other. Demographics, diagnoses, health care utilization, BP measurements, and medications were obtained as part of routine care. We used random effects logistic regression models to examine race as a predictor of blood pressure control (<140/90 mm Hg) at 6 months post-discharge, adjusted for SES, age, gender, dementia, antihypertensive therapy, and attendance at follow-up visits. At 6 months, BP was controlled in 52.7% of blacks compared to 61.4% of whites (OR = 0.63, 95% CI, 0.48-0.82, P = .001). Black race remained independently associated with poorer BP control in adjusted analysis, although blacks were as likely to attend post-discharge visits, and more likely to be on any antihypertensive therapy than whites. Greater difficulty in controlling BP and lifestyle differences may account for this difference.
authors.affiliation: Kaiser Permanente Division of Research, Oakland, CA, USA; Department of Neurology, Kaiser Permanente Walnut Creek, Walnut Creek, CA, USA. Electronic address: mai.n.nguyen-huynh@kp.org.
authors.forename: Mai N
authors.initials: MN
authors.lastname: Nguyen-Huynh
authors.affiliation: Department of Neurology, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Nancy K
authors.initials: NK
authors.lastname: Hills
authors.affiliation: Kaiser Permanente Division of Research, Oakland, CA, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Sidney
authors.affiliation: Department of Neurology, Kaiser Permanente Walnut Creek, Walnut Creek, CA, USA.
authors.forename: Jeffrey G
authors.initials: JG
authors.lastname: Klingman
authors.affiliation: Dell Medical School, University of Texas at Austin, Austin, TX, USA.
authors.forename: S Claiborne
authors.initials: SC
authors.lastname: Johnston
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001795:Blood Pressure Determination / Q000379:methods / Q000706:statistics & numerical data; D002140:California / Q000453:epidemiology; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000208:ethnology / Q000209:etiology; D008019:Life Style / Q000208:ethnology; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D011446:Prospective Studies; D012959:Socioeconomic Factors; D020521:Stroke / Q000150:complications / Q000517:prevention & control; D000095223:White; D001741:Black or African American
chemical_list: D000959:Antihypertensive Agents
keywords: Epidemiology; hypertension; prevention; stroke