Hunter K Holt, MD, MAS; Ginny Gildengorin, PhD; Leah Karliner, MD, MAS; Valy Fontil, MD, MAS, MPH; Rajiv Pramanik, MD; Michael B Potter, MD
Corresponding Author: Hunter K Holt, MD, MAS; Department of Family and Community Medicine - University of California, San Francisco. Email: Hunter.holt@ucsf.edu
Section: Original Research
Publication Date: 1/13/2022
Background: National guidelines recommend different pharmacologic management of hypertension (HTN) without comorbidities for Black/African Americans (BAA) compared to 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 18-85 with HTN on one- or two-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 (≥140/90mmhg) compared to 39.0% of non-BAA (P<0.001). 61.8% of BAA were treated with 1-drug compared to 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 to 38.0% of non-BAA (P<0.001). Of BAA on 2 drugs, 48.2% had uncontrolled HTN compared to 41.1% of non-BAA (P<0.001). For each drug regimen, there was more variation in HTN control within each group than between BAA and non-BAA. Conclusions: Providers appear 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.