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

Abstract

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 b-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%); b-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.

Clinical, Laboratory, Imaging and Electrocardiographic Differences between Patients with Lyme Disease and Patients with Lyme Disease and B. divergens Antibodies

“…Babesia canis infection induced cardiac disorders in dogs with 32% of AV block [33]. Two reports showed myocardial damage and serious arrhtymia associated with severe babesiosis in two American patients [34,35]. A recent report showed that 19.6% of hospitalized American patients with acute babesiosis due to B. microti developed cardiac complications, mostly atrial fibrillation, heart failure, QT interval prolongation and cardiac ischemia [36].…”

Diuretic Use in Black Patients With Uncontrolled Hypertension

“…A recent study of treated black patients in an ambulatory clinic found that 39% reported receiving a diuretic. 7 One would expect that among black patients with uncontrolled hypertension, the proportion prescribed a diuretic would be higher. In this context, the 46% reported in this study has to be considered strikingly low and adds to the evidence that use of diuretics seems to be suboptimal.…”

“…4 Despite the reported efficacy for use of thiazide diuretics and potassium-sparing diuretics in blacks, 5,6 a recent study of treated black patients in an ambulatory clinic found that only 39% of patients reported taking a diuretic. 7 Several large trials have reported that the cardiovascular outcome after treatment with "newer" classes of agents (angiotensin-converting enzyme inhibitors (ACEIs), angiotensin-receptor blockers (ARBs), and calcium channel blockers (CCBs) is not superior to that after treatment with the "older" diuretic agents. 8 Furthermore, the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) reported that in black patients the outcome was better after treatment with diuretics than after treatment with ACEIs.…”

How Well Do We Care for Patients With Hypertension?

“…18 A careful examination of hypertension care of innercity African Americans was reported from Brooklyn by Dr Esosa Odigie-Okon and colleagues. 19 In assessing practice patterns in that community, these authors found that 50% of treated black patients were at their BP goals. About 60% of these patients were receiving >1 drug.…”