Racial and Geographic Differences in Awareness, Treatment, and Control of Hypertension

Abstract

Background and Purpose-Stroke mortality is higher in the "Stroke Belt" and among blacks in the United States. Because hypertension is the leading risk factor for stroke, hypertension management (raising awareness, increasing treatment, and improving control) may reduce these disparities. Methods-Hypertension awareness, treatment, and control were measured in the REasons for Geographic And Racial Differences in Stroke study, a national population-based cohort of black and white participants Ͼ45 years of age. At the time of this report, 11 701 had been enrolled. Racial differences and geographic differences (between the Stroke Belt and other regions of the United States) were described. Results-Black participants were more aware than whites of their hypertension (odds ratio [OR], 1.31; 95% CI, 1.07 to 1.59) and more likely to be on treatment if aware of their diagnosis (OR, 1.69; 95% CI, 1.40 to 2.05), but among those treated for hypertension, they were less likely than whites to have their blood pressure controlled (OR, 0.73; 95% CI, 0.64 to 0.83). There was no evidence of a difference between the Stroke Belt and other regions in awareness of hypertension (OR, 0.95; 95% CI, 0.79 to 1.14), but there was a trend for better treatment (OR, 1.15; 95% CI, 0.97 to 1.37) and control (OR, 1.11; 95% CI, 0.98 to 1.30) in the Stroke Belt region. Conclusions-These findings suggest that interventions to improve blood pressure control among blacks are promising to reduce the racial disparity in stroke mortality. The lack of substantial geographic differences in hypertension awareness and the trend toward better treatment and control in the Stroke Belt suggest that differences in hypertension management may not be a major contributor to the geographic disparity in stroke mortality.

Demographic and Geographic Vascular Risk Factor Differences in European Young Adults With Ischemic Stroke

“…Geographic variance in the prevalence of cardiovascular risk factors in the population occurs in the United States, 22,23 Canada, 24 and Europe. 25,26 In addition, national and regional variance in such risk factors have been observed in global surveys.…”

Stroke Epidemiology: Advancing Our Understanding of Disease Mechanism and Therapy

“…Many studies have examined the various risk factors for stroke and their prevalence and control among different racial ethnic groups. Blacks consistently have higher rates of hypertension [70][71][72]. The diabetes rate was alarmingly high among Native Americans (62%) [73].…”

Factors Associated with Misperception of Weight in the Stroke Belt

“…Blacks are at 4 times greater risk for stroke by 45 years of age than are whites. 4 Trying to reduce the proportion of people in a population who are overweight or obese could reduce health risks. Even modest weight reduction has been shown to have beneficial results in the reduction of one's risk for cardiovascular disease, type 2 diabetes, and hypertension.…”

“…11 Residents of the Stroke Belt, the southeastern region of the United States, are at 50% greater risk of dying from stroke than residents of other regions. 4 Practitioners of general Internal Medicine aware of the variety of factors associated with misperceiving ones actual weight status will be better able to provide effective advice and counseling to patients on maintaining a healthy weight.…”