Abstract 12725: The Role of Hypertension in Black-White Disparities in Angiographic Coronary Artery Disease
Introduction: Despite higher cardiovascular mortality, black patients are less likely to have significant angiographic disease than whites. The etiology of this paradox remains unclear. A potential explanation is the differential impact of hypertension between these two race groups; the effects of hypertension, particularly on the heart, are greater in blacks than whites, and hypertensive heart disease may mimic coronary artery disease (CAD) and lead to catheterization despite a lack of underlying vessel stenosis.
Hypothesis: We tested the hypothesis that hypertension is associated with the black-white differences in CAD in patients undergoing elective angiography.
Methods: We analyzed clinical and angiographic data for patients undergoing a first elective angiography in 2001–2008 at an academic hospital. We compared rates of angiographic disease for blacks and whites, adjusted for baseline differences and stratified according to hypertension history. We then tested for interaction between race and hypertension on angiographic findings.
Results: Of the 1,203 white and 2,538 black patients who underwent initial elective angiography, black patients were less likely to have a significant stenosis (≥50% left main stenosis or ≥70% stenosis elsewhere) than whites (adjusted odds ratio (aOR) 0.54; 95% CI 0.44–0.66). In hypertensive patients, this difference was exaggerated (aOR 0.47; 95% CI 0.38–0.59), whereas, in non-hypertensive patients, the odds of having a significant lesion were similar in blacks and whites (aOR 0.95; 95% CI 0.60–1.53). The interaction term for race and hypertension was statistically significant.
Conclusions: Racial differences in angiographic CAD were found only for patients with a history of hypertension. Black and white patients without a history of hypertension had nearly identical rates of significant CAD. It appears that hypertension or its effects may be responsible for the disproportionate number of negative studies in black patients referred for coronary angiography. Further studies are needed to identify the specific effects of hypertension in blacks that are associated with negative angiography; this may have implications for clinical decision making in patients presenting for evaluation of suspected CAD.
- © 2010 by American Heart Association, Inc.