Recognition and Management of Hypertension in Older Persons: Focus on African Americans

Still, Carolyn H; Ferdinand, Keith C.; Ogedegbe, Gbenga; Wright, Jackson T.

doi:10.1111/jgs.13672

Cited by 15 publications

(16 citation statements)

References 63 publications

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“…We recognize that participation in such a healthcare system does not guarantee equal treatment; however, it can minimize disparate racial access. Another strength is that our data displays the added advantage of having cancer-specific outcomes especially since other common causes of mortality, including cardiovascular disease, also have racial disparities [27,28]. Unlike studies based only on cancer registry data, we included comorbidity data such as CKD.…”

Section: Discussionmentioning

confidence: 99%

Racial disparities in renal cell carcinoma: a single‐payer healthcare experience

Mafolasire

Yao²,

Nawaf

et al. 2016

Cancer Medicine

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Significant racial disparities in survival for renal cell carcinoma (RCC) exist between white and black patients. Differences in access to care and comorbidities are possible contributors. To investigate if racial disparities persist when controlling for access to care, we analyzed data from a single-payer healthcare system. As part of a case-control study within the Kaiser Permanente Northern California system, pathologic and clinical records were obtained for RCC cases (2152 white, 293 black) diagnosed from 1998 to 2008. Patient demographics, comorbidities, tumor characteristics, and treatment status were compared. Overall survival and disease-specific survival (DSS) were calculated by the Kaplan-Meier method. A Cox proportion hazards model estimated the independent associations of race, comorbidity, and clinicopathologic variables with DSS. We found that compared to white patients, black patients were diagnosed at a younger age (median 62 vs. 66 years, P < 0.001), were more likely to have papillary RCC (15% vs. 5.2%, P < 0.001), and had similar rates of surgical treatment (78.8% vs. 77.9%, P = 0.764). On multivariate analysis, advanced American Joint Committee on Cancer (AJCC) stage, lack of surgical treatment, larger tumor size, and higher grade were predictors of worse DSS. Race was not an independent predictor of survival. Therefore, we conclude that within a single healthcare system, differences in characteristics of black and white patients with RCC persist; black patients had different comorbidities, were younger, and had decreased tumor stage. However, unlike other series, race was not an independent predictor of DSS, suggesting that survival differences in large registries may result from barriers to healthcare access and/or comorbidity rather than disease biology. Cancer Medicine Open Access 2102

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Section: Discussionmentioning

confidence: 99%

Racial disparities in renal cell carcinoma: a single‐payer healthcare experience

Mafolasire

Yao²,

Nawaf

et al. 2016

Cancer Medicine

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“…[1] Moreover, hypertension in African Americans begins earlier, is more severe, and more frequently associated with premature morbidity and mortality from its complications including coronary heart disease, heart failure, stroke, and end-stage renal disease (ESRD). [2-6] Racial/ethnic disparities in hypertension and related outcomes continue to pose immense challenges for affected individuals and the healthcare system.…”

Section: Introductionmentioning

confidence: 99%

“…[3, 5, 7-14] Despite recommendations on prescription of antihypertensive therapies, achieving BP control remains problematic and data on optimal BP targets remain controversial. [1, 2, 6] The 2011-2012 National Health and Examination Survey (NHANES III) data suggested that 76% of US adults with hypertension were taking antihypertensives, with a higher percentage of African Americans (79.7%) than European Americans (76.6%). [1] Despite antihypertensive treatment, nearly 50% of U.S. adults with hypertension were not controlled to the currently recommended target of <140/90 mmHg.…”

Section: Introductionmentioning

confidence: 99%

“…[1] Despite antihypertensive treatment, nearly 50% of U.S. adults with hypertension were not controlled to the currently recommended target of <140/90 mmHg. [1, 4, 6] Among treated hypertensive African Americans, 49.5% achieved BP control compared to 53.9% of European Americans. [1]…”

Section: Introductionmentioning

confidence: 99%

“…[6, 15-18] However, findings have been reported to differ by racial/ethnic groups, and African Americans were often underrepresented in clinical trials. [18, 19] Some have advocated for lower BP targets and lower thresholds for initiating BP medications for African Americans compared to the rest of the population.…”

Section: Introductionmentioning

confidence: 99%

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Baseline characteristics of African Americans in the Systolic Blood Pressure Intervention Trial

Still

Craven

Freedman

et al. 2015

Journal of the American Society of Hypertension

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The Systolic Blood Pressure Intervention Trial (SPRINT) will compare treatment to a systolic blood pressure goal of <120 mmHg to treatment to the currently recommended goal of <140 mmHg for effects on incident cardiovascular, renal, and neurologic outcomes including cognitive decline. Objectives The objectives of this analysis are to compare baseline characteristics of African American (AA) and non-AA SPRINT participants and explore factors associated with uncontrolled blood pressure (BP) by race. Methods SPRINT enrolled 9,361 hypertensive participants over age 50. This cross-sectional analysis examines sociodemographics, baseline characteristics, and study measures among AAs compared to non-AAs. Results AAs made up 31% of participants. AAs (compared to non-AAs) were younger and less frequently male, had less education, and were more likely uninsured or covered by Medicaid. In addition, AAs scored lower on the cognitive screening test when compared to non-AAs. Multivariable logistic regression analysis found BP control rates to <140/90 mmHg were higher for AAs who were male, had higher number of chronic diseases, were on diuretic treatment, and had better medication adherence. Conclusion SPRINT is well poised to examine the effects of SBP targets on clinical outcomes as well as predictors influencing BP control in AAs.

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Antihypertensive Medication and Dementia Risk in Older Adult African Americans with Hypertension: A Prospective Cohort Study

et al. 2018

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BackgroundAfrican Americans are especially at risk of hypertension and dementia. Antihypertensive medications reduce the risk of cardiovascular events, but may also reduce the risk of dementia.ObjectiveTo assess the longitudinal effects of antihypertensive medications and blood pressure on the onset of incident dementia in a cohort of African Americans.DesignProspective cohort.Participants1236 community-dwelling patients from an inner-city public health care system, aged 65 years and older, with a history of hypertension but no history of dementia, and who had at least three primary care visits and a prescription filled for any medication.Main MeasuresBlood pressure was the average of three seated measurements. Dementia was diagnosed using a two-stage design, with a screening evaluation every 2 to 3 years followed by a comprehensive in-home clinical evaluation for those with a positive screen. Laboratory, inpatient and outpatient encounter data, coded diagnoses and procedures, and medication records were derived from a health information exchange.Key ResultsOf the 1236 hypertensive participants without dementia at baseline, 114 (9%) developed incident dementia during follow-up. Individuals prescribed any antihypertensive medication (n = 816) were found to have a significantly reduced risk of dementia (HR = 0.57, 95% CI 0.37–0.88, p = 0.0114) compared to untreated hypertensive participants (n = 420). When this analysis was repeated including a variable indicating suboptimally treated blood pressure (> 140 mmHg systolic or >90 mmHg diastolic), the effect of antihypertensive medication was no longer statistically significant (HR = 0.65, 95% CI 0.32–1.30, p = 0.2217).ConclusionsControl of blood pressure in older adult African American patients with hypertension is a key intervention for preventing dementia, with similar benefits from most of the commonly available antihypertensive medications.Electronic supplementary materialThe online version of this article (10.1007/s11606-017-4281-x) contains supplementary material, which is available to authorized users.

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Recognition and Management of Hypertension in Older Persons: Focus on African Americans

Cited by 15 publications

References 63 publications

Racial disparities in renal cell carcinoma: a single‐payer healthcare experience

Racial disparities in renal cell carcinoma: a single‐payer healthcare experience

Baseline characteristics of African Americans in the Systolic Blood Pressure Intervention Trial

Antihypertensive Medication and Dementia Risk in Older Adult African Americans with Hypertension: A Prospective Cohort Study

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