Racial Differences in Blood Pressure Control Following Stroke: The REGARDS Study

Abstract

Background and Purpose: In the general population, Black adults are less likely than White adults to have controlled blood pressure (BP), and when not controlled, they are at greater risk for stroke compared with White adults. High BP is a major modifiable risk factor for recurrent stroke, but few studies have examined racial differences in BP control among stroke survivors. Methods: We used data from the REGARDS study (Reasons for Geographic and Racial Differences in Stroke) to examine disparities in BP control between Black and White adults, with and without a history of stroke. We studied participants taking antihypertensive medication who did and did not experience an adjudicated stroke (n=306 and 7693 participants, respectively) between baseline (2003–2007) and a second study visit (2013–2016). BP control at the second study visit was defined as systolic BP <130 mm Hg and diastolic BP <80 mm Hg except for low-risk adults ≥65 years of age (ie, those without diabetes, chronic kidney disease, history of cardiovascular disease, and with a 10-year predicted atherosclerotic cardiovascular disease risk <10%) for whom BP control was defined as systolic BP <130 mm Hg. Results: Among participants with a history of stroke, 50.3% of White compared with 39.3% of Black participants had controlled BP. Among participants without a history of stroke, 56.0% of White compared with 50.2% of Black participants had controlled BP. After multivariable adjustment, there was a tendency for Black participants to be less likely than White participants to have controlled BP (prevalence ratio, 0.77 [95% CI, 0.59–1.02] for those with a history of stroke and 0.92 [95% CI, 0.88–0.97] for those without a history of stroke). Conclusions: There was a lower proportion of controlled BP among Black compared with White adults with or without stroke, with no statistically significant differences after multivariable adjustment.

A 10-year review of antihypertensive prescribing practices after stroke and the associated disparities from the Florida Stroke Registry

“…We found that African Americans had a lower odd of having the Prescribers’-Choice Adherence to guidelines-based BP medications after stroke with 1 in 2 patients not prescribed guideline based first choice agents. This is consistent with prior work 17, 23, 24, 32-35 on race ethnic disparities in hypertension and stroke management such as the REGARDs 32 study. This disparity persisted even after controlling for insurance type, age, and other medical comorbidities and not related to patient compliance to medication but rather a prescriber’s choice of antihypertensive medication after a stroke.…”

Racial Disparities in Stroke Recurrence

“…38 Social determinants and structural inequities could also limit the efficacy of secondary stroke prevention in Black individuals, for instance, regarding blood pressure control. 39 Thus, while our results provide hope that targeting modifiable stroke risk factors could reduce disparities in recurrence, this is unlikely to be achieved without understanding and addressing the structural inequities that contribute to these risk factors in the first place. There is some evidence that risk factor modification can be achieved, but success depends on organizational approaches to poststroke care that may address some of these disparities.…”

Hypertension as a risk factor for atherosclerosis: Cardiovascular risk assessment

“…Meta-analysis of individual data for 1 million adults examined in 61 prospective studies revealed that over the entire range of values of normal SBP decreasing to 115 mmHg, the slope of the relationship between mortality from CHD (plotted on a double scale) and normal levels of SBP was approximately constant in each age range, although the relative strength of the association was weaker for CHD than for stroke mortality in middle ages ( 39 ). Moreover, for the relationship between mortality from CHD and the usual values of diastolic blood pressure (DBP) decreasing to 75 mmHg, the age-related HRs associated with differences of 10 mmHg in the usual DBP are equivalent to those associated with differences of 20 mmHg in the usual values of SBP ( 40 ).…”