PT  - JOURNAL ARTICLE
AU  - Hunter K. Holt
AU  - Ginny Gildengorin
AU  - Leah Karliner
AU  - Valy Fontil
AU  - Rajiv Pramanik
AU  - Michael B. Potter
TI  - Differences in Hypertension Medication Prescribing for Black Americans and Their Association with Hypertension Outcomes
AID  - 10.3122/jabfm.2022.01.210276
DP  - 2022 Jan 01
TA  - The Journal of the American Board of Family
                Medicine
PG  - 26--34
VI  - 35
IP  - 1
4099  - http://www.jabfm.org/content/35/1/26.short
4100  - http://www.jabfm.org/content/35/1/26.full
SO  - J Am Board Fam Med2022 Jan 01; 35
AB  - 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.