Abstract P311: Antihypertensive Medication Prescribing Varies by Race/Ethnicity Among U.S. Patients with Chronic Kidney Disease
Background The prevalence of chronic kidney disease (CKD) is increasing in the U.S., leading to greater numbers of patients progressing to kidney failure and associated cardiovascular disease morbidity and mortality. Hypertension control is essential to slow or halt CKD progression. Blacks are almost four times as likely as whites to develop kidney failure. Among Hispanics, the rate of kidney failure has increased 70% since 2000. Both groups experience higher rates of CKD progression than do non-Hispanic whites.
Hypothesis We hypothesized that blacks and Hispanics with CKD would be less likely to receive recommended treatments compared to whites.
Methods The National Disease and Therapeutic Index (IMS Health; Plymouth, PA) is a national sample of U.S. office-based patient visits during which patient and visit characteristics are recorded, including diagnoses and prescription medications. We assessed the mean number of selected antihypertensive agents reported at visits by adult patients (age 18+ years) with CKD grouped by race/ethnicity (white, black, Hispanic), 1994-2012. The selected drug classes assessed included ACE inhibitors or angiotensin receptor blockers (ARBs), diuretics, and beta blockers or calcium channel blockers.
Results The mean number of antihypertensive agents reported per visit rose over time for all groups (Figure, part A). White patients received on average 0.2 more prescriptions per visit than did black or Hispanic patients. When subdivided by antihypertensive class, differences persisted. For black patients, lower ACE inhibitor/ARB prescribing compared to whites contributed most to recent disparities (Figure, part B), but differential prescribing of diuretics and beta blockers/calcium channels blockers also contributed.
Conclusions Black and Hispanic patients with CKD received fewer prescriptions for antihypertensive medications than their white counterparts, suggesting that differential antihypertensive prescribing contributes to disparities in CKD progression.
- © 2013 by American Heart Association, Inc.