Abstract P049: Race/Ethnic Differences in Patterns of Antihypertensive Medication Uptake and Clinical Outcomes among Hospitalized Diabetic Patients with Hypertension
Background: Hypertension increases the risk of complications in patients with diabetes. Race/ethnic differences in the uptake of antihypertensive medications may contribute to disparities in clinical outcomes, but this has not been formally evaluated. We aimed to assess patterns of antihypertensive medication prescription by race/ethnic group and the association with clinical outcomes among hospitalized diabetic patients with hypertension.
Methods: This was a 1 year prospective study of individuals with existing diabetes and hypertension (N=1126, 42% black/Hispanic [minority]; 39% female) that participated in an NHLBI clinical outcomes study of patients admitted to a cardiovascular service. Baseline clinical/medication data and outcomes (rehospitalization/death) were documented by electronic medical record, National Death Index, and standardized mail survey. Logistic regression was used to evaluate associations between race/ethnicity, antihypertensive prescription, and outcomes adjusted for demographics/comorbidities.
Results: Overall utilization of antihypertensive medication prior to admission did not differ between minority (92%) vs. white/other (93%) patients; minorities were more likely to report taking calcium channel blockers (OR=1.40;95%CI=1.08-1.81) and less likely to use beta blockers (OR=0.65;95%CI=0.50-0.84) vs. whites/others. Race/ethnic differences in prescription type did not persist at discharge after adjustment for demographics/comorbidities (96% prescribed any antihypertensive medication: 62% ACE inhibitor/ARB, 81% beta blocker, 29% calcium channel blocker, 48% diuretic). A total of 676 (60%) of participants were rehospitalized/dead at 1 year; predictors of rehospitalization/death included minority race/ethnicity, lack of health insurance, renal failure/dialysis, peripheral vascular disease, and heart failure (p<0.05). Prescription of beta blocker (OR=0.60;95%CI=0.43-0.82) was associated with lower odds of rehospitalization/death at 1 year. Race/ethnic minority status remained a significant predictor of death/rehospitalization at 1 year after adjustment demographics, comorbidities and beta blocker prescription at discharge (OR=1.31;95%CI=1.01-1.71).
Conclusion: In this study of hospitalized diabetic patients with hypertension, antihypertensive prescription at discharge did not vary by race/ethnicity; beta blocker prescription at discharge was associated with lower odds of rehospitalization/death at 1 year. Higher odds of rehospitalization/death among minorities was not explained by measured covariates including type of antihypertension medication.
Author Disclosures: H. Mochari-Greenberger: None. L. Mosca: None.
- © 2014 by American Heart Association, Inc.