People of African/African Caribbean ethnicity were less likely to achieve blood pressure control one year after antihypertensive initiation compared to those of European ethnicity (OR 0.81), a difference that attenuated after accounting for treatment persistence.
Cohort (n=782,141)
Yes
Does South Asian or African/African Caribbean ethnicity affect blood pressure control and hypertension management compared to European ethnicity in antihypertensive-naïve adults with a new raised BP reading?
While antihypertensive initiation rates do not vary adversely by ethnicity, subsequent blood pressure control is significantly lower in people of African/African Caribbean ethnicity, largely driven by lower rates of treatment persistence and adherence.
Odds Ratio: 0.81 (95% CI 0.74–0.89)
Absolute Event Rate: 46% vs 52%
Background: In the UK, previous work suggests ethnic inequalities in hypertension management. We studied ethnic differences in hypertension management and their contribution to blood pressure (BP) control. Methods: We conducted a cohort study of antihypertensive-naïve individuals of European, South Asian and African/African Caribbean ethnicity with a new raised BP reading in UK primary care from 2006 to 2019, using the Clinical Practice Research Datalink (CPRD). We studied differences in: BP re-measurement after an initial hypertensive BP, antihypertensive initiation, BP monitoring, antihypertensive intensification, antihypertensive persistence/adherence and BP control one year after antihypertensive initiation. Models adjusted for socio-demographics, BP, comorbidity, healthcare usage and polypharmacy (plus antihypertensive class, BP monitoring, intensification, persistence and adherence for BP control models). Findings: A total of 731,506 (93.5%), 30,379 (3.9%) and 20,256 (2.6%) people of European, South Asian and African/African Caribbean ethnicity were studied. Hypertension management indicators were similar or more favourable for South Asian than European groups (OR/HR 95% CI in fully-adjusted models of BP re-measurement: 1.16 1.09, 1.24), antihypertensive initiation: 1.49 1.37, 1.62, BP monitoring: 0.97 0.94, 1.00 and antihypertensive intensification: 1.10 1.04, 1.16). For people of African/African Caribbean ethnicity, BP re-measurement rates were similar to those of European ethnicity (0.98 0.91, 1.05), and antihypertensive initiation rates greater (1.48 1.32, 1.66), but BP monitoring (0.91 0.87, 0.95) and intensification rates lower (0.93 0.87, 1.00). Persistence and adherence were lower in South Asian (0.48 0.45, 0.51 and 0.51 0.47, 0.56) and African/African Caribbean (0.38 0.35, 0.42 and 0.39 0.36, 0.43) than European groups. BP control was similar in South Asian and less likely in African/African Caribbean than European groups (0.98 0.90, 1.06 and 0.81 0.74, 0.89 in age, gender and BP adjusted models). The latter difference attenuated after adjustment for persistence (0.91 0.82, 0.99) or adherence (0.92 0.83, 1.01), and was absent for antihypertensive-adherent people (0.99 0.88, 1.10). Interpretation: We demonstrate that antihypertensive initiation does not vary by ethnicity, but subsequent BP control was notably lower among people of African/African Caribbean ethnicity, potentially associated with being less likely to remain on regular treatment. A nationwide strategy to understand and address differences in ongoing management of people on antihypertensives is imperative. Funding: Diabetes UK.
Eastwood et al. (Mon,) conducted a cohort in Hypertension (n=782,141). African/African Caribbean ethnicity vs. European ethnicity was evaluated on Blood pressure control one year after antihypertensive initiation (OR 0.81, 95% CI 0.74-0.89). People of African/African Caribbean ethnicity were less likely to achieve blood pressure control one year after antihypertensive initiation compared to those of European ethnicity (OR 0.81), a difference that attenuated after accounting for treatment persistence.