Racial and Ethnic Disparities in Stroke Among Hypertensive Adults by Antihypertensive Medication Use in the United States

Despite improvements in hypertension management, racial and ethnic disparities in stroke persist. Whether intervention intensity modifies stroke disparities remains unclear. We analyzed 10,005 adults aged ≥ 20 years with hypertension in the National Health and Nutrition Examination Survey from March 2013 to March 2020. Stroke history was self-reported. Antihypertensive therapy was categorized as untreated, monotherapy, or combination therapy. Multivariable logistic regression models adjusted for demographic, socioeconomic, and clinical variables and included a race/ethnicity × medication group interaction term. Outcomes were reported as odds ratios (OR) and accompanying 95% confidence intervals (CI). 5% of the studied population reported a history of stroke. After full adjustment, current smoking (OR = 1.80, 95% CI 1.27-2.56), history of cardiovascular disease (OR = 2.38, 95% CI 1.70-3.35), and Medicaid insurance (OR = 3.06, 95% CI 1.40-6.68) were independently associated with stroke. Descriptive differences in stroke prevalence varied across race/ethnicity and antihypertensive medication categories; however, the race/ethnicity x medication interaction was not statistically significant (p = 0.346). Among untreated participants, predicted stroke prevalence was 3.5% in Black participants and 2.8% in White participants, compared to 7.0% and 6.8%, respectively, among those receiving combination therapy. Compared with White participants, Asian participants demonstrated lower odds of stroke on combination therapy (adjusted OR 0.23, 95% CI 0.06-0.96) compared with untreated individuals (adjusted OR 0.49, 95% CI 0.22-1.09). Hispanic participants demonstrated lower odds of stroke relative to White participants across medication categories (adjusted OR = 0.57, 95% CI 0.37-0.90 combination therapy vs. adjusted OR = 0.66, 95% CI 0.48-0.92 untreated). Stroke prevalence differed by race/ethnicity and antihypertensive medication category; however, no statistically significant evidence was found that treatment intensity modified racial/ethnic disparities. Larger longitudinal studies incorporating blood pressure control, medication adherence, and hypertension severity are needed to better understand the relationship between antihypertensive treatment intensity and racial/ethnic differences in stroke risk.