• Hunter K Holt, Ginny Gildengorin, Leah Karliner, Valy Fontil, Rajiv Pramanik, and Michael B Potter.
• From the Department of Family and Community Medicine at the University of Illinois at Chicago (HKH); Department of Family and Community Medicine, University of California San Francisco (MBP); Division of General Internal Medicine, Department of Medicine, University of California San Francisco (GG, LK, VF); Multiethnic Health Equity Research Center, University of California San Francisco (LK, VF); UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, CA (VF); Contra Costa Health Services, San Francisco, CA (RP).
• J Am Board Fam Med. 2022 Jan 1; 35 (1): 263426-34.

BackgroundNational guidelines recommend different pharmacologic management of hypertension (HTN) without comorbidities for Black/African Americans (BAA) compared with non-BAA. We sought to 1) identify if these recommendations have influenced prescription patterns in BAA and 2) identify the differences in uncontrolled HTN in BAA on different antihypertensive medications.MethodsWe constructed a linked retrospective observational cohort using 2 years of electronic health records data, comprising of patients aged 18 to 85 with HTN on 1- or 2-drug regimens, including angiotensin-converting enzyme inhibitors (ACE), angiotensin receptor blockers (ARB), thiazide diuretics, or calcium channel blockers (CCB). We examined prescribing differences and HTN control in BAA versus non-BAA.ResultsAmong 10,875 patients identified, 20.6% were identified as BAA. 46.4% of BAA had uncontrolled HTN (≥140/90 mmHg) compared with 39.0% of non-BAA (P < .001). 61.8% of BAA were treated with 1-drug compared with 68.4% of non-BAA. Of BAA on monotherapy: 41.3% were on thiazide, 40.1% on CCB, and 18.6% on ACE/ARB. Of non-BAA on monotherapy, 27.7% were on thiazide, 30.1% were on CCB, and 42.3% were on ACE/ARB. Of BAA patients on 1 drug, 45.2% had uncontrolled HTN compared with 38.0% of non-BAA (P < .001). Of BAA on 2 drugs, 48.2% had uncontrolled HTN compared with 41.1% non-BAA (P < .001). For each drug regimen, there was more variation in HTN control within each group than between BAA and non-BAA.ConclusionsProviders seem to be following race-based guidelines for HTN, yet HTN control for BAA remains worse than non-BAA. An individualized approach to HTN therapy for all patients may be more important than race-based guidelines.© Copyright 2022 by the American Board of Family Medicine.

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