Background
Race and geographic differences in the prevalence and predictors of hypertension in stroke survivors have been reported, but apparent treatment-resistant hypertension (aTRH) among stroke survivors by race (African ancestry vs Non-Hispanic Caucasians) and by geography (continental Africa versus the United States) are under studied.
Methods
This is a cross-sectional study using ethically approved stroke registries from the University of Florida and the Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. Univariate and multivariate regression was used to evaluate for differences in prevalence of aTRH and associations with clinical covariates.
Results
Harmonized data were available for 3,365 stroke survivors of which 943 (28.0%) were indigenous Africans, 558 (16.6%) African Americans and 1864 (55.4%) Non-Hispanic Caucasians with median ages (IQR) of 59 (49 - 68) years, 61 (55-72) years and 70 (62-78) years, p<0.0001. The overall frequency of aTRH was 18.5% (95% CI: 17.2-19.8%) with 42.7% (95% CI: 39.6–46.0%) among indigenous Africans, 16.1% (95% CI: 13.2-19.5%) among African Americans and 6.9% (95% CI: 5.8–8.2%) among non-Hispanic Caucasians, p<0.0001. Five factors associated with aTRH: age, adjusted odds-ratio (95% CI) of 0.99 (0.98-0.99), female sex 0.70 (0.56-0.87), cigarette smoking 1.98 (1.36–2.90), intracerebral hemorrhage 1.98 (1.57-2.48) and Black race namely indigenous Africans 4.42 (3.41-5.73)and African Americans 2.44 (1.81 – 3.29).
Conclusions
Future studies are needed to investigate the contribution of socioeconomic disparities in the prevalence aTRH in those with African Ancestry to explore the long-term impact, and evaluate effective therapeutic interventions in this subpopulation.
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