Antihypertensive Therapy in African Americans: Findings From an Inner‐City Ambulatory Clinic

J Clin Hypertens (Greenwich). 2010;12:187–192. ^©2010 Wiley Periodicals, Inc. African Americans bear a greater burden of hypertension. Understanding prevailing epidemiologic patterns can facilitate the implementation and successful outcome of community programs. The authors assessed practice patterns of antihypertensive drug utilization and blood pressure (BP) control in a predominantly African American population in Brooklyn, NY, from January 1 to January 31, 2008. A total of 416 (53.1%) had hypertension, with a mean age of 61 years, and 267 (64%) were women. In general, 212 (50.9%) were at goal BP and 59.9% of those at goal were taking at least 2 drugs. Patient age correlated with the number of drugs used (r=0.14; P=.004). Patients taking β‐blockers and calcium channel blockers were older: 63.6 vs 60.1 years (P=.01) and 62.7 vs 60.3 years (P=.07), respectively. The pattern of antihypertensive use was as follows: angiotensin‐converting enzyme inhibitors, 194 (46.6%); calcium channel blockers, 162 (38.9%); diuretics, 162 (38.9%); β‐blockers, 133(32%); and angiotensin receptor blockers, 93 (22.4%). The findings of age associated with the class of medications used and a predominance of angiotensin‐converting enzyme inhibitors usage highlight possible gaps in appropriateness of antihypertensive therapy. The application of age‐appropriate race‐based antihypertensive therapy might improve BP control rates. These results strengthen arguments for investing in community‐based programs to overcome possible provider‐related and local health system barriers to achieving BP control goals.

Hypertension is the most common primary diagnosis in America and is responsible for 35.7 million office visits per year. ¹ Overall, 1 in 3 American adults have high blood pressure (BP), while 2 in 5 African American adults have high BP. ² African Americans bear a greater burden of disease, ^{3 , 4} have a variable response to conventional antihypertensive medications, ^{5 , 6} and develop more severe end‐organ damage. ^{7 , 8} In addition to pharmacologic therapy and lifestyle modifications, community‐based interventions focusing on African Americans may improve outcomes. In this light, the Centers for Disease Control and Prevention (CDC) has initiated the Racial and Ethnic Approaches to Community Health Across the US (REACH US) program. ^{9 , 10 , 11 , 12} Similarly, the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) ¹³ recommends a 3‐pronged approach of pharmacologic therapy, lifestyle changes, and public health initiatives involving community participation and mobilization. Pharmacologic therapy remains a primary focus of care, however, as it prevents and reverses end‐organ damage and improves cardiovascular outcomes. ^{14 , 15} Correspondingly, to ensure a cost‐effective, sustainable, and successful community‐based intervention, the intensity and design of public health programs involving grassroots initiatives ought to be guided by a clear understanding of prevailing epidemiologic patterns of hypertension.As such, the CDC calls for continuous surveillance of health status in minority communities so that culturally sensitive prevention strategies can be tailored to these communities and program interventions evaluated. ¹⁶ Knowledge of existing prescribing patterns, antihypertensive drug utilization, and BP control rates in the index community can provide useful information for establishing community programs to combat hypertension and gauge their effectiveness. We assessed practice patterns and BP control in a predominantly African American population serviced by a community health clinic affiliated with an internal medicine residency program.