Key result
African American diabetic hypertensives attain BP <130/80 ~25% less often than Caucasians despite more prescriptions.
Why the study?
Are there ethnic differences in blood pressure control and antihypertensive prescribing patterns between African American and Caucasian patients with diabetes and hypertension?
Cross-Sectional (n=19,864)
Yes
Are there ethnic differences in blood pressure control and antihypertensive prescribing patterns between African American and Caucasian patients with diabetes and hypertension?
Absolute Event Rate: 23.1% vs 30.7%
Provider prescribing patterns do not appear to be the major contributor to poorer blood pressure control in African American diabetic hypertensives compared to Caucasians, as they receive more antihypertensive medications including ACEIs/ARBs.
Disparities in BP control persist in African American diabetic hypertensives despite more prescriptions; leaves open non-prescribing factors and requires prospective study.
Among diabetic hypertensive patients, ethnic differences in blood pressure control and outcomes have been attributed in part to greater reluctance of providers to prescribe combination antihypertensive regimens to African Americans than to Caucasians. African Americans purportedly receive fewer angiotensin-converting enzyme inhibitors (ACEIs) and/or angiotensin receptor blockers (ARBs), which reduce target organ complications. To assess these issues, cross-sectional data were analyzed from 19,864 diabetic hypertensives from 62 primary care clinics. Among diabetic hypertensives, African Americans (N=6230) were less likely than Caucasians (N=8041) to have blood pressure (BP) <130/80 mm Hg at their last clinic visit (23.1% [23.0%-23.2%] vs. 30.7% [30.6%-30.9%]) despite a greater number of prescriptions for antihypertensive medications (2.67 [2.63-2.70] vs. 2.23 [2.20-2.26]). African Americans were more likely than Caucasians to have an ACEI and/or ARB prescribed and to receive prescriptions for at least two antihypertensive medications that included an ACEI or ARB (64.1% [63.8%-64.4%] vs. 53.1% [52.8%-53.4%]). Among diabetic hypertensives, African Americans are less likely than Caucasians to attain BP <130/80 mm Hg, despite receiving more antihypertensive medication prescriptions. African Americans receive more ACEIs and/or ARBs than Caucasians for target organ protection and/or BP control. The data suggest provider prescribing patterns are not a major contributor to ethnic differences in BP control and outcomes in diabetic hypertensives.
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RIEHLE et al. (2005) conducted a cross-sectional in diabetic hypertension (n=19,864). African American ethnicity vs. Caucasian ethnicity was evaluated on blood pressure <130/80 mm Hg at last clinic visit. African American diabetic hypertensives were less likely than Caucasians to attain blood pressure <130/80 mm Hg (23.1% vs 30.7%) despite receiving more antihypertensive prescriptions.
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