Ethnic differences in the treatment and control of hypertension in patients with diabetes

Among diabetic hypertensive patients, ethnic differences in blood pressure control and outcomes have been attributed in part to greater reluctance of providers to prescribe combination antihypertensive regimens to African Americans than to Caucasians. African Americans purportedly receive fewer angiotensin-converting enzyme inhibitors (ACEIs) and/or angiotensin receptor blockers (ARBs), which reduce target organ complications. To assess these issues, cross-sectional data were analyzed from 19,864 diabetic hypertensives from 62 primary care clinics. Among diabetic hypertensives, African Americans (N=6230) were less likely than Caucasians (N=8041) to have blood pressure (BP) <130/80 mm Hg at their last clinic visit (23.1% [23.0%-23.2%] vs. 30.7% [30.6%-30.9%]) despite a greater number of prescriptions for antihypertensive medications (2.67 [2.63-2.70] vs. 2.23 [2.20-2.26]). African Americans were more likely than Caucasians to have an ACEI and/or ARB prescribed and to receive prescriptions for at least two antihypertensive medications that included an ACEI or ARB (64.1% [63.8%-64.4%] vs. 53.1% [52.8%-53.4%]). Among diabetic hypertensives, African Americans are less likely than Caucasians to attain BP <130/80 mm Hg, despite receiving more antihypertensive medication prescriptions. African Americans receive more ACEIs and/or ARBs than Caucasians for target organ protection and/or BP control. The data suggest provider prescribing patterns are not a major contributor to ethnic differences in BP control and outcomes in diabetic hypertensives.