title: Effect of Race and Ethnicity on Antihypertensive Medication Utilization Among Women in the United States: Study of Women's Health Across the Nation (SWAN).
abstract: BACKGROUND
  Antihypertensive medication use may vary by race and ethnicity. Longitudinal antihypertensive medication use patterns are not well described in women.
  
  
  RESULTS
  Participants from the Study of Women's Health Across the Nation (SWAN), a prospective cohort of women (n=3302, aged 42-52), who reported a diagnosis of hypertension or antihypertensive medication use at any annual visit were included. Antihypertensive medications were grouped by class and examined by race/ethnicity adjusting for potential confounders in logistic regression models. A total of 1707 (51.7%) women, mean age 50.6 years, reported hypertension or used antihypertensive medications at baseline or during follow-up (mean 9.1 years). Compared with whites, blacks were almost 3 times as likely to receive a calcium channel blocker (odds ratio, 2.92; 95% CI, 2.24-3.82) and twice as likely to receive a thiazide diuretic (odds ratio, 2.38; 95% CI, 1.93-2.94). Blacks also had a higher probability of reporting use of ≥2 antihypertensive medications (odds ratio, 1.95; 95% CI, 1.55-2.45) compared with whites. Use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and thiazide diuretics increased over time for all racial/ethnic groups. Contrary to our hypothesis, rates of β-blocker usage did not decrease over time.
  
  
  CONCLUSIONS
  Among this large cohort of multiethnic midlife women, use of antihypertensive medications increased over time, with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers becoming the most commonly used antihypertensive medication, even for blacks. Thiazide diuretic utilization increased over time for all race/ethnic groups as did use of calcium channel blockers among blacks; both patterns are in line with guideline recommendations for the management of hypertension.
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI lisjacks@med.umich.edu.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Jackson
authors.affiliation: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA.
authors.forename: Kristine
authors.initials: K
authors.lastname: Ruppert
authors.affiliation: The Saul R. Korey Department of Neurology, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Carol A
authors.initials: CA
authors.lastname: Derby
authors.affiliation: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA.
authors.forename: Yinjuan
authors.initials: Y
authors.lastname: Lian
authors.affiliation: Division of Reproductive Endocrinology & Infertility, Department of Obstetrics and Gynecology, University of Washington, Seattle, WA.
authors.forename: Genevieve
authors.initials: G
authors.lastname: Neal-Perry
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, CA.
authors.forename: Laurel A
authors.initials: LA
authors.lastname: Habel
authors.affiliation: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA.
authors.forename: Ping G
authors.initials: PG
authors.lastname: Tepper
authors.affiliation: Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI.
authors.forename: Siobán D
authors.initials: SD
authors.lastname: Harlow
authors.affiliation: Division of Rheumatology, Division of Pharmacoepidemiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Solomon
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000208:ethnology; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D016017:Odds Ratio; D044469:Racial Groups; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D016387:Women's Health
chemical_list: D000959:Antihypertensive Agents
keywords: disparities; hypertension; medication; race/ethnicity; women