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Racial Differences in Blood Pressure Control from Users of Antihypertensive Monotherapy: Results from the ELSA-Brasil
Camila Tavares Sousa1, Antonio Ribeiro2, Sandhi Maria Barreto2
1Universidade Federal de São João Del-Rei - Campus Centro-Oeste Dona Lindu, Divinópolis, MG - Brasil.
Insights
Black adults in Brazil using certain blood pressure medications showed worse control, even after accounting for drug effectiveness. This highlights racial disparities in hypertension management beyond medication type.
Area of Science:
- Cardiovascular Health
- Public Health
- Pharmacogenomics
Background:
- Hypertension control disparities exist, particularly in Black populations, potentially linked to antihypertensive drug response.
- Existing evidence primarily stems from American studies, necessitating research in diverse populations.
Purpose of the Study:
- To examine the relationship between self-reported race/skin color and blood pressure (BP) control.
- To investigate this association across different classes of antihypertensive drugs used in monotherapy within the ELSA-Brasil cohort.
Main Methods:
- Cross-sectional analysis of baseline data from the Longitudinal Study of Adult Health (ELSA-Brasil).
- BP control defined as <140/90 mmHg; race/skin color self-reported (White, Brown, Black).
- Logistic regression used to assess the association between BP control and race/skin color, adjusting for confounders.
Main Results:
- Among 1,795 antihypertensive monotherapy users, 55.5% were White, 27.9% Brown, and 16.7% Black.
- Black individuals exhibited worse BP control compared to Whites across multiple drug classes, including ACE inhibitors, ARBs, thiazide diuretics, and beta-blockers, even after adjustment.
Conclusions:
- In Brazilian adults, racial differences in BP control are not explained by the purported lower effectiveness of ACE inhibitors and ARBs in Black individuals.
- Findings suggest other factors contribute to hypertension management disparities in this population.
Background:
It seems that the worst response to some classes of antihypertensive drugs, especially angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, on the part of the Black population, would at least partially explain the worse control of hypertension among these individuals. However, most of the evidence comes from American studies.
Objectives:
This study aims to investigate the association between self-reported race/skin color and BP control in participants of the Longitudinal Study of Adult Health (ELSA-Brasil), using different classes of antihypertensive drugs in monotherapy.
Methods:
The study involved a cross-sectional analysis, carried out with participants from the baseline of ELSA-Brasil. Blood pressure control was the response variable, participants with BP values ≥140/90 mmHg were considered out of control in relation to blood pressure levels. Race/skin color was self-reported (White, Brown, Black). All participants were asked about the continuous use of medication. Association between BP control and race/skin color was estimated through logistic regression. The level of significance adopted in this study was of 5%.
Results:
Of the total of 1,795 users of antihypertensive drugs in monotherapy at baseline, 55.5% declared themselves White, 27.9% Brown, and 16.7% Black. Even after adjusting for confounding variables, Blacks using angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blocker (ARB), thiazide diuretics (thiazide DIU), and beta-blockers (BB) in monotherapy had worse blood pressure control compared to Whites.
Conclusions:
Our results suggest that in this sample of Brazilian adults using antihypertensive drugs in monotherapy, the differences in blood pressure control between different racial groups are not explained by the possible lower effectiveness of ACEIs and ARBs in Black individuals.
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