Racial/Ethnic differences in medication uptake and clinical outcomes among hospitalized cardiovascular patients with hypertension and diabetes.

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. © American Journal of Hypertension, Ltd 2014. All rights reserved. For Permissions, please email: journals.permissions@oup.com.