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Research ArticleOriginal Research

Differences in Hypertension Medication Prescribing for Black Americans and Their Association with Hypertension Outcomes

Hunter K. Holt, Ginny Gildengorin, Leah Karliner, Valy Fontil, Rajiv Pramanik and Michael B. Potter
The Journal of the American Board of Family Medicine January 2022, 35 (1) 26-34; DOI: https://doi.org/10.3122/jabfm.2022.01.210276
Hunter K. Holt
From the Department of Family and Community Medicine at the University of Illinois at Chicago (HKH); Department of Family and Community Medicine, University of California San Francisco (MBP); Division of General Internal Medicine, Department of Medicine, University of California San Francisco (GG, LK, VF); Multiethnic Health Equity Research Center, University of California San Francisco (LK, VF); UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, CA (VF); Contra Costa Health Services, San Francisco, CA (RP).
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Ginny Gildengorin
From the Department of Family and Community Medicine at the University of Illinois at Chicago (HKH); Department of Family and Community Medicine, University of California San Francisco (MBP); Division of General Internal Medicine, Department of Medicine, University of California San Francisco (GG, LK, VF); Multiethnic Health Equity Research Center, University of California San Francisco (LK, VF); UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, CA (VF); Contra Costa Health Services, San Francisco, CA (RP).
PhD
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Leah Karliner
From the Department of Family and Community Medicine at the University of Illinois at Chicago (HKH); Department of Family and Community Medicine, University of California San Francisco (MBP); Division of General Internal Medicine, Department of Medicine, University of California San Francisco (GG, LK, VF); Multiethnic Health Equity Research Center, University of California San Francisco (LK, VF); UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, CA (VF); Contra Costa Health Services, San Francisco, CA (RP).
MD, MAS
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Valy Fontil
From the Department of Family and Community Medicine at the University of Illinois at Chicago (HKH); Department of Family and Community Medicine, University of California San Francisco (MBP); Division of General Internal Medicine, Department of Medicine, University of California San Francisco (GG, LK, VF); Multiethnic Health Equity Research Center, University of California San Francisco (LK, VF); UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, CA (VF); Contra Costa Health Services, San Francisco, CA (RP).
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Rajiv Pramanik
From the Department of Family and Community Medicine at the University of Illinois at Chicago (HKH); Department of Family and Community Medicine, University of California San Francisco (MBP); Division of General Internal Medicine, Department of Medicine, University of California San Francisco (GG, LK, VF); Multiethnic Health Equity Research Center, University of California San Francisco (LK, VF); UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, CA (VF); Contra Costa Health Services, San Francisco, CA (RP).
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Michael B. Potter
From the Department of Family and Community Medicine at the University of Illinois at Chicago (HKH); Department of Family and Community Medicine, University of California San Francisco (MBP); Division of General Internal Medicine, Department of Medicine, University of California San Francisco (GG, LK, VF); Multiethnic Health Equity Research Center, University of California San Francisco (LK, VF); UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, CA (VF); Contra Costa Health Services, San Francisco, CA (RP).
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Abstract

Background: National guidelines recommend different pharmacologic management of hypertension (HTN) without comorbidities for Black/African Americans (BAA) compared with non-BAA. We sought to 1) identify if these recommendations have influenced prescription patterns in BAA and 2) identify the differences in uncontrolled HTN in BAA on different antihypertensive medications.

Methods: We constructed a linked retrospective observational cohort using 2 years of electronic health records data, comprising of patients aged 18 to 85 with HTN on 1- or 2-drug regimens, including angiotensin-converting enzyme inhibitors (ACE), angiotensin receptor blockers (ARB), thiazide diuretics, or calcium channel blockers (CCB). We examined prescribing differences and HTN control in BAA versus non-BAA.

Results: Among 10,875 patients identified, 20.6% were identified as BAA. 46.4% of BAA had uncontrolled HTN (≥140/90 mmHg) compared with 39.0% of non-BAA (P < .001). 61.8% of BAA were treated with 1-drug compared with 68.4% of non-BAA. Of BAA on monotherapy: 41.3% were on thiazide, 40.1% on CCB, and 18.6% on ACE/ARB. Of non-BAA on monotherapy, 27.7% were on thiazide, 30.1% were on CCB, and 42.3% were on ACE/ARB. Of BAA patients on 1 drug, 45.2% had uncontrolled HTN compared with 38.0% of non-BAA (P < .001). Of BAA on 2 drugs, 48.2% had uncontrolled HTN compared with 41.1% non-BAA (P < .001). For each drug regimen, there was more variation in HTN control within each group than between BAA and non-BAA.

Conclusions: Providers seem to be following race-based guidelines for HTN, yet HTN control for BAA remains worse than non-BAA. An individualized approach to HTN therapy for all patients may be more important than race-based guidelines.

  • Health Equity
  • Hypertension
  • Precision Medicine
  • Prescriptions
  • Primary Health Care
  • Retrospective Studies
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The Journal of the American Board of Family     Medicine: 35 (1)
The Journal of the American Board of Family Medicine
Vol. 35, Issue 1
January/February 2022
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Differences in Hypertension Medication Prescribing for Black Americans and Their Association with Hypertension Outcomes
Hunter K. Holt, Ginny Gildengorin, Leah Karliner, Valy Fontil, Rajiv Pramanik, Michael B. Potter
The Journal of the American Board of Family Medicine Jan 2022, 35 (1) 26-34; DOI: 10.3122/jabfm.2022.01.210276

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Differences in Hypertension Medication Prescribing for Black Americans and Their Association with Hypertension Outcomes
Hunter K. Holt, Ginny Gildengorin, Leah Karliner, Valy Fontil, Rajiv Pramanik, Michael B. Potter
The Journal of the American Board of Family Medicine Jan 2022, 35 (1) 26-34; DOI: 10.3122/jabfm.2022.01.210276
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  • Health Equity
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