Anna Gu1, Yu Yue2, Raj P Desai2, Edgar Argulian1. 1. From the Department of Pharmacy Administration and Public Health, St. John's University, Queens, NY (A.G., R.P.D.); Paul H. Chook Department of Information Systems and Statistics, Baruch College, City University of New York (Y.Y.); and Division of Cardiology, Mt Sinai St. Luke's Hospital, New York, NY (E.A.). gus@stjohns.edu eargulian@chpnet.org. 2. From the Department of Pharmacy Administration and Public Health, St. John's University, Queens, NY (A.G., R.P.D.); Paul H. Chook Department of Information Systems and Statistics, Baruch College, City University of New York (Y.Y.); and Division of Cardiology, Mt Sinai St. Luke's Hospital, New York, NY (E.A.).
Abstract
BACKGROUND: A key to reduce and eradicate racial disparities in hypertension outcomes is to understand their causes. We aimed at evaluating racial differences in antihypertensive drug utilization patterns and blood pressure control by insurance status, age, sex, and presence of comorbidities. METHODS AND RESULTS: A total of 8796 hypertensive individuals ≥18 years of age were identified from the National Health and Nutrition Examination Survey (2003-2012) in a repeated cross-sectional study. During the study period, all 3 racial groups (whites, blacks, and Hispanics) experienced substantial increase in hypertension treatment and control. The overall treatment rates were 73.9% (95% confidence interval [CI], 71.6%-76.2%), 70.8% (95% CI, 68.6%-73.0%), and 60.7% (95% CI, 57.0%-64.3%) and hypertension control rates were 42.9% (95% CI, 40.5%-45.2%), 36.9% (95% CI, 34.7%-39.2%), and 31.2% (95% CI, 28.6%-33.9%) for whites, blacks, and Hispanics, respectively. When stratified by insurance status, blacks (odds ratio, 0.74 [95% CI, 0.64-0.86] for insured and 0.59 [95% CI, 0.36-0.94] for uninsured) and Hispanics (odds ratio, 0.74 [95% CI, 0.60-0.91] for insured and 0.58 [95% CI, 0.36-0.94] for uninsured) persistently had lower rates of hypertension control compared with whites. Racial disparities also persisted in subgroups stratified by age (≥60 and <60 years of age) and presence of comorbidities but worsened among patients <60 years of age. CONCLUSIONS: Black and Hispanic patients had poorer hypertension control compared with whites, and these differences were more pronounced in younger and uninsured patients. Although black patients received more intensive antihypertensive therapy, Hispanics were undertreated. Future studies should further explore all aspects of these disparities to improve cardiovascular outcomes.
BACKGROUND: A key to reduce and eradicate racial disparities in hypertension outcomes is to understand their causes. We aimed at evaluating racial differences in antihypertensive drug utilization patterns and blood pressure control by insurance status, age, sex, and presence of comorbidities. METHODS AND RESULTS: A total of 8796 hypertensive individuals ≥18 years of age were identified from the National Health and Nutrition Examination Survey (2003-2012) in a repeated cross-sectional study. During the study period, all 3 racial groups (whites, blacks, and Hispanics) experienced substantial increase in hypertension treatment and control. The overall treatment rates were 73.9% (95% confidence interval [CI], 71.6%-76.2%), 70.8% (95% CI, 68.6%-73.0%), and 60.7% (95% CI, 57.0%-64.3%) and hypertension control rates were 42.9% (95% CI, 40.5%-45.2%), 36.9% (95% CI, 34.7%-39.2%), and 31.2% (95% CI, 28.6%-33.9%) for whites, blacks, and Hispanics, respectively. When stratified by insurance status, blacks (odds ratio, 0.74 [95% CI, 0.64-0.86] for insured and 0.59 [95% CI, 0.36-0.94] for uninsured) and Hispanics (odds ratio, 0.74 [95% CI, 0.60-0.91] for insured and 0.58 [95% CI, 0.36-0.94] for uninsured) persistently had lower rates of hypertension control compared with whites. Racial disparities also persisted in subgroups stratified by age (≥60 and <60 years of age) and presence of comorbidities but worsened among patients <60 years of age. CONCLUSIONS: Black and Hispanic patients had poorer hypertension control compared with whites, and these differences were more pronounced in younger and uninsured patients. Although black patients received more intensive antihypertensive therapy, Hispanics were undertreated. Future studies should further explore all aspects of these disparities to improve cardiovascular outcomes.
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