Black, Hispanic adults may have poorer hypertension control than white patients

Black and Hispanic patients with hypertension had poorer control of their condition compared with white patients with hypertension, according to a cross-sectional study.

The researchers found the differences in hypertension were more pronounced in younger and uninsured patients.

Lead researcher Anna Gu, MD, MPH, of St. John’s University in Queens, New York, and colleagues published their results online in Circulation: Cardiovascular Quality and Outcomes on Jan. 17.

“Expanded healthcare coverage would help minimize this problem, but there are multiple factors that contribute to this disparity,” Gu said in a news release. “We need better patient education, better physician-patient communication and support for patients making lifestyle changes like exercising more and eating healthy. The good news is that more people are receiving treatment and getting their high blood pressure under control. At the same time, it is important to note that disparities between whites and racial and ethnic minorities persist.”

The trial examined 8,796 adults who were at least 18 years old and enrolled from 2003 to 2012 in the National Health and Nutrition Examination Survey, which was conducted by the CDC's National Center for Health Statistics.

During the study, participants had detailed in-person interviews and then underwent follow-up physical examinations. They also provided blood and urine specimens during the physical examination that was used in laboratory testing.

Patients had hypertension if they met one or more of the following criteria: systolic blood pressure of 140 mm Hg or higher, diastolic blood pressure of 90 mm Hg or an affirmative response when asked if they were taking medications to lower their blood pressure.

Patients without chronic kidney disease and diabetes were considered to have their hypertension under control in they had a systolic blood pressure below 140 mm Hg and a diastolic blood pressure below 90 mm Hg. Patients with either comorbidity were considered to have their hypertension under control in they had a systolic blood pressure below 130 mm Hg and a diastolic blood pressure below 80 mm Hg.

The rate of hypertension control increased from 33.0 percent in 2003 to 2004 to 44.9 percent in 2011 to 2012.

During the study, the rates of hypertension control were 42.9 percent for whites, 36.9 percent for blacks and 31.2 percent for Hispanics. The rates increased from 34.6 percent in 2003 to 20034 to 47.2 percent in 2011 to 2012 for whites, from 30.2 percent to 39.2 percent for blacks and from 22.3 percent to 36.9 percent for Hispanics.

The researchers noted that the proportion of adults who reported taking an antihypertensive medication increased from 65.6 percent in 2003 to 2004 to 77.3 percent in 2010 to 2012. The rates increased from 66.9 percent to 78.8 percent for whites, from 63 percent to 76 percent for blacks and from 57.1 percent to 68.3 percent for Hispanics.

The rates of antihypertensive medications were 73.9 percent for whites, 70.8 percent for blacks and 60.7 percent for Hispanics. Diuretics were the most common antihypertensive drug class, accounting for more than one-third of prescriptions.

The researchers also mentioned that uninsured Hispanic and black patients had an approximately 40 percent lower odds of achieving hypertension control compared with white patients. They noted, as well, that younger Hispanic and black patients were approximately 40 percent less likely than whites to achieve hypertension control.

They added that the study had a few limitations, including its observational design and residual confounding. They could not for all of the potential reasons for racial differences in hypertension treatment and control, and they did not have information on patients’ long-term adherence to antihypertensive medications.

“Despite major improvements in hypertension treatment and control during the 10-year study period, the racial differences in these measures persist,” the researchers wrote. “Future efforts should focus on systematically exploring and addressing these differences.”