Effect of African American Race on Hypertension Management: A Real-world Observational Study among 28 US Physician Practices

To assess the impact of African American race on hypertension management among a real-world hypertensive population. Cross-sectional study. 28 US physician practices. Adult patients with a hypertension diagnosis between November 2006 and September 2008. Blood pressure (BP) control (< 140/90 mm Hg for non-diabetic, and < 130/80 mm Hg for diabetic, patients). African American patients (n = 1,079) were younger than Caucasian patients (n = 3,884) (60.2 vs 66.0 years, P < .01), were more likely to be female (60.1% vs 52.5%, P < .01), were more likely to be obese (55.9% vs 48.5%, P < .01) and had a higher diabetes prevalence (29.4% vs 23.8%, P < .01). African American hypertensive patients had significantly higher BP as compared to Caucasian hypertensive patients (135.2/82.9 mm Hg vs 130.5/76.4 mm Hg, P < .01). Both diabetic and non-diabetic African Americans were prescribed more antihypertensive medications than Caucasians and were more likely to be prescribed combination regimens. African Americans were less likely to be prescribed beta blockers, and more likely to be prescribed calcium channel blockers or diuretics. Among non-diabetic and diabetic patients, African Americans had 54% and 53% lower adjusted odds, respectively, of controlled BP. The use of specific antihypertensive medication classes was not associated with BP control. Although African Americans were prescribed more aggressive medication regimens, they had lower probability of BP control. While African American race influenced the choice of prescribed antihypertensive medications, those regimens did not affect the probability of BP control. African American race should not deter providers from prescribing specific antihypertensive medication classes, particularly in the presence of compelling indications.