Abstract TMP97: Temporal Trends in Black-White Differences of Antihypertensive Treatment in Individuals With and Without History of Stroke: Reasons for Geographic and Racial Differences in Stroke (REGARDS)

Abstract

Introduction: In 2014, the Eighth Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC8) included race-specific recommendations for antihypertensive treatments (e.g. calcium channel blockers [CCBs] for Black persons). The impact of these guidelines on anti-hypertensive regimen changes over time, and if this varied by prevalent stroke status, is unclear. Methods: REGARDS participants reporting anti-hypertensive medications with and without history of stroke who completed an in-home examination in 2003-2007 (Visit 1) or 2013-2016 (Visit 2) were included. Logistic regression mixed models estimated odds ratios (OR) and 95% confidence intervals (CI) for use of each antihypertensive class for Visit 2 vs. Visit 1 and Black vs. White with interaction by prevalent stroke status, adjusted for demographic and socioeconomic status. Results: Of 17,222 participants without prevalent stroke at Visit 1, Black participants had greater odds of ACE-inhibitor usage relative to White participants (OR 1.68, 95% CI 1.44-1.95). This difference remained but was smaller in 7,476 participants without stroke at Visit 2 (OR 1.29, CI 1.20-1.38). In participants without prevalent stroke, lower odds of CCB usage among Black compared to White participants was observed at Visit 1 (OR 0.47, CI 0.41-0.55) but there was no difference at Visit 2 (OR 1.00, CI 0.94-1.07). Among 1,436 participants with prevalent stroke at Visit 1, Black participants had lower odds of CCB use compared to White participants (OR 0.48, CI 0.29-0.82) but similar odds in 689 participants with prevalent stroke at Visit 2 (OR 1.15, CI 0.91-1.44). Conclusions: Consistent with JNC8 recommendations for first-line medication administration in Black persons with hypertension, there was a higher likelihood of CCB use over time among Black participants in REGARDS. Adherence to race-based guidance for antihypertensive medication may be increasing over time.