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

Article Figures & Data

Figures

  • Figure 1a)
    Figure 1a)

    Median and interquartile ranges of blood pressures for Black/African Americans and Non-Black/African Americans on 1-drug regimens. Figure 1b) Median and interquartile ranges of blood pressures for Black/African Americans and Non-Black/African Americans on 2-drug regimens. Abbreviations: BP, Blood Pressure; CCB, Calcium Channel Blocker; ACE, Angiotensin-Converting Enzyme Inhibitor; ARB, Angiotensin Receptor Blocker.

Tables

  • Table 1.

    Sociodemographic and Baseline Characteristics

    CharacteristicTotal Population N = 10,875 (%)Black/African American Population N = 2,245 (%)Non-BAA PopulationN = 8,630 (%)P value
    Age (mean + SD)56.2 + 12.052.4 + 11.457.1 + 12.0<0.001*
    Sex (female)6289 (57.8)1262 (56.2)5027 (58.3)0.082†
    # of PCP visits0.040†
        1 to 23825 (36.9)752 (35.1)3073 (37.3)
        3 to 42853 (27.5)579 (27.0)2274 (27.6)
        5 or more visits3695(35.6)812 (37.9)2883 (35.0)
    Insurance status0.001†
        Insured10226 (94.0)2059 (91.7)8167 (94.6)
        Uninsured585 (5.4)172 (7.7)413 (4.8)
        Other/unknown64 (0.6)14 (0.6)50 (0.6)
    Current Smoker1991 (18.3)869 (38.7)1122 (13.0)0.001†
    BMI<0.001†
        Less than 252915 (27.7)436 (20.2)2479 (29.7)
        25 to 303554 (33.8)596 (27.6)2958 (35.4)
        >304038 (38.4)1126 (52.2)2912 (34.9)
    Language (English)7995 (73.4)2175 (97.0)5800 (67.3)<0.001†
    Clinical Site<0.001†
        Health System 13362 (30.9)391 (17.4)2971 (34.4)
        Health system 23710 (34.1)886 (39.5)2824 (32.7)
        Health System 33803 (35.0)968 (43.1)2835 (32.9)

    • Abbreviations: BAA, Black/African American; BMI, body mass index; PCP, primary care physician; SD, standard deviation.

    • ↵* T-Test.

    • ↵† Pearson's Chi-Square Test.

  • Table 2.

    Pharmacological Treatment Characteristics

    CharacteristicTotal Population N = 10,875 (%)Black/African American Population N = 2,245 (%)Non-BAA PopulationN = 8,630 (%)P value
    # of drug classes0.001*
        1 drug7292 (67.1)1388 (61.8)5904 (68.4)
        2 drugs3583 (32.9)857 (38.2)2726 (31.6)
    1-Drug Regimens0.001*
        ACE or ARB only2754 (37.8)258 (18.6)2496 (42.3)
        Thiazide only2206 (30.3)573 (41.3)1633 (27.7)
        CCB only2332 (32.0)557 (40.1)1775 (30.1)
    2-Drug Regimens0.001*
        Thiazide + CCB846 (23.6)307 (35.8)539 (19.8)
        Thiazide + ACE/ARB1727 (48.2)380 (44.3)1347 (49.4)
        CCB + ACE/ARB1010 (28.2)170 (19.8)840 (30.8)

    • Abbreviations: BAA, Black/African American; CCB, Calcium Channel Blocker; ACE, Angiotensin-Converting Enzyme Inhibitor; ARB, Angiotensin Receptor Blocker.

    • ↵* Pearson's Chi-Square Test.

  • Table 3.

    Odds of Uncontrolled Blood Pressure (≥140/90 mmHg) Among Black/African American Patients on One- and Two-Drug anti-Hypertensive Regimens

    One Drug Regimen (n = 1327)Two Drug Regimen (n = 815)
    PredictoraOR (95% CI)*P valueaOR (95% CI)*P value
    Age0.99 (0.98-1.00)0.030.98 (0.97-1.00)0.03
    1-Drug Regimen
        Thiazide1.00Referent
        Calcium Channel Blocker1.53 (1.19-1.97)0.001
        ACE/ARB1.70 (1.25-2.33)0.001
    2-Drug Regimen
        Thiazide + CCB1.00Referent
        Thiazide + ACE/ARB0.81 (0.59-1.12)0.20
        CCB + ACE/ARB1.12 (0.74-1.68)0.59
    Sex
        Female1.00Referent1.00Referent
        Male0.83 (0.66-1.04)0.100.82 (0.61-1.10)0.18
    Insurance Status
        Insured1.00Referent1.00Referent
        Uninsured1.13 (0.75-1.73)0.550.91 (0.52-1.60)0.75
        Other/Unknown1.89 (0.43-8.37)0.400.54 (0.09-3.34)0.51
    No. of PCP Visits
        1 to 21.00Referent1.00Referent
        3 to 40.71 (0.53-0.94)0.020.42 (0.29-0.62)<0.0001
        5 or more visits0.57 (0.43-0.75)<0.00010.48 (0.34-0.67)<0.0001
    Clinical Site
        Health System 11.00Referent1.00Referent
        Health System 22.04 (1.56-2.66)<0.00012.31 (1.64-3.25)<0.0001
        Health System 31.59 (1.15-2.20)<0.00011.40 (0.90-2.19)0.13

    • Abbreviations: ACE, Angiotensin-Converting Enzyme Inhibitor; aOR, adjusted odds ratio; ARB, Angiotensin receptor blocker; BAA, Black/African American; CCB, Calcium Channel Blocker; CI, confidence interval; PCP, primary care physician.

    • ↵* Adjusted for all variables included in the table.

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