Blood Pressure Control Among Non-Hispanic Black Adults Is Lower Than Non-Hispanic White Adults Despite Similar Treatment With Antihypertensive Medication: NHANES 2013–2018

Abstract

Background Controlled blood pressure can prevent or reduce adverse health outcomes. Social and structural determinants may contribute to the disparity that despite equivalent proportions on anti-hypertensive medication, non-Hispanic Black (Black) adults have lower blood pressure control and more cardiovascular events than non-Hispanic White (White) adults. Methods Data from 2013-2018 National Health and Nutrition Examination Survey were pooled to assess control among Black and White adults by anti-hypertensive medication use and selected characteristics using the 2017 American College of Cardiology/American Heart Association (ACC/AHA) Blood Pressure Guideline definition (systolic blood pressure <130 mm Hg and diastolic blood pressure <80 mm Hg) among 4,739 adults. Results Among those treated with anti-hypertensive medication, an estimated 34.9% of Black and 45.0% of White adults had controlled blood pressure. Control was lower for Black and White adults among most subgroups of age, sex, education, insurance status, usual source of care, and poverty-income ratio. Black adults had higher use of diuretics (28.5%--Black adults vs. 23.5%--White adults) and calcium channel blockers (24.2%--Black adults vs. 14.7%--White adults) compared to White adults. Control among Black adults was lower than White adults across all medication classes including diuretics (36.1%--Black adults vs. 47.3%--White adults), calcium channel blockers (30.2%--Black adults vs. 40.1%--White adults), and number of medication classes used. Conclusions Sub-optimal blood pressure control rates and disparities warrant increased efforts to improve control, which could include addressing social and structural determinants along with emphasizing implementation of the 2017 ACC/AHA Blood Pressure Guideline into clinical practice.

Social Determinants of Health–Related Z Codes and Health Care Among Patients With Hypertension

“… 34 Even among those taking antihypertensive medications by medication class, differences in the proportion of adults with controlled hypertension have been observed by race/ethnicity and SES. 35 This suggests that some patients with hypertension need additional support for healthcare and lifestyle management, which has implications for cardiovascular disease risk. For example, among a national, population-based sample (age ≥45 years) without coronary heart disease at baseline, greater SDOH burdens were associated with fatal incident coronary heart disease than among those without SDOH burdens.…”

Relationship Between Diet Quality and Antihypertensive Medication Intensity Among Adults With Metabolic Syndrome-Associated High Blood Pressure

“… 24 We graded the intensity of BP-lowering medication according to the number of BP-lowering medication classes used simultaneously, in accordance with the International Society of Hypertension guidelines 7 and as done in previous studies. 25 , 26 In sensitivity analyses, we graded intensity of medication using the number of antihypertensive pills to take into account polypharmacy burden as well as the fact that some classes can be combined in a single pill. 27 Finally, we assessed medication intensity using the Therapeutic Intensity Score (TIS).…”