Antihypertensive Medication Use and Its Effects on Blood Pressure and Haemodynamics in a Tri-ethnic Population Cohort: Southall and Brent Revisited (SABRE)

Abstract

Objectives:We characterised differences in BP control and use of antihypertensive medications in European (EA), South Asian (SA) and African-Caribbean (AC) people with hypertension and investigated the potential role of type 2 diabetes (T2DM), reduced arterial compliance (Ca), and antihypertensive medication use in any differences.Methods:Analysis was restricted to individuals with hypertension [age range 59–85 years; N = 852 (EA = 328, SA = 356, and AC =168)]. Questionnaires, anthropometry, BP measurements, echocardiography, and fasting blood assays were performed. BP control was classified according to UK guidelines operating at the time of the study. Data were analysed using generalised structural equation models, multivariable regression and treatment effect models.Results:SA and AC people were more likely to receive treatment for high BP and received a greater average number of antihypertensive agents, but despite this a smaller proportion of SA and AC achieved control of BP to target [age and sex adjusted odds ratio (95% confidence interval) = 0.52 (0.38, 0.72) and 0.64 (0.43, 0.96), respectively]. Differences in BP control were partially attenuated by controlling for the higher prevalence of T2DM and reduced Ca in SA and AC. There was little difference in choice of antihypertensive agent by ethnicity and no evidence that differences in efficacy of antihypertensive regimens contributed to ethnic differences in BP control.Conclusions:T2DM and more adverse arterial stiffness are important factors in the poorer BP control in SA and AC people. More effort is required to achieve better control of BP, particularly in UK ethnic minorities.

Ethnic differences in hypertension management, medication use and blood pressure control in UK primary care, 2006–2019: a retrospective cohort study

“…However, our finding of higher rates of timely antihypertensive initiation for people of South Asian or African/African Caribbean than European ethnicity is corroborated by previous UK cross-sectional studies demonstrating higher proportions of treated hypertension in the former ethnic groups. 6 , 16 Furthermore, a systematic review of studies from Europe showed similar rates of treatment for South Asian and European groups, and higher rates in African groups, partly supporting our findings. 18 Explanations are uncertain; a possibility is physician perception of heightened CVD risk in these groups, following the propagation of guidelines and risk scores emphasising this.…”

“…As far as we are aware, no studies simultaneously compare all these factors by ethnicity, nor examine their contribution to ethnic differences in BP control. Further, UK South Asian and African/African Caribbean populations have far higher rates of diabetes than white European groups 5 and our previous work suggests ethnic differences in BP control are partly explained by diabetes, 6 but this requires substantiation in larger datasets.…”

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“… Antihypertensive Drug: Antihypertensive drugs may decrease cardiac output by either inhibiting myocardial contractility or reducing ventricular filling pressure 6 .…”

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“…Hypertension is expected to impact up to 1 billion individuals around the world, resulting in 7.1 million deaths per year. It is estimated that 1% of high-risk patients will experience a high blood pressure at some point, and that hypertensive incidents report for 25% of all clinical visits to the clinical stage of an emergency unit (EU), with hypertensive incidents being identified in one-third of such cases 1 .…”