Racial/ethnic disparities in medication use among veterans with hypertension and dementia: a national cohort study

Ann Pharmacother. 2009 Feb;43(2):185-93. doi: 10.1345/aph.1L368. Epub 2009 Feb 3.


Background: Hypertension and comorbid dementia are common illnesses affecting older adults disproportionally. Medication adherence is vital in achieving therapeutic outcomes. Use of antihypertensive and dementia medications may vary by race/ethnicity and has not been well explored.

Objective: To evaluate the utilization of antihypertensive and dementia drugs and adherence in a national cohort of veterans aged 65 years or older with a diagnosis of both hypertension and dementia across different racial/ethnic groups.

Methods: This was a retrospective cohort study that used 2 national databases of the Veterans Health Administration to estimate medication utilization and adherence rates among whites, African Americans, and Hispanics from 2000 to 2005. A medication possession ratio of 0.8 or greater defined adherence. The association between race/ethnicity and adherence was analyzed using multivariate logistic regression analysis.

Results: A total of 56,561 patients (70.5% white, 15.6% African American, 6.6% Hispanic) aged 65 years or older had diagnoses of dementia and hypertension. African Americans were less likely than whites to receive angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), beta-blockers, acetylcholinesterase inhibitors, and memantine (p < 0.05). Hispanics were more likely than whites to be prescribed an ACE inhibitor and less likely to be prescribed an ARB, beta-blocker, nondihydropyridine calcium-channel blocker (CCB), loop diuretic, alpha-agonist, or potassium-sparing diuretic (PSD) (p < 0.05). Medication adherence was significantly lower in African Americans than whites in all classes except for ARBs, loop diuretics, and PSDs (p < 0.05). Being Hispanic was associated with significantly lower adherence rates than whites for dihydropyridine CCBs and acetylcholinesterase inhibitors (p < 0.05).

Conclusions: Racial/ethnic differences exist in antihypertensive and dementia medication use in a cohort of older adults with hypertension and dementia. Adherence rates for a number of antihypertensive and dementia drugs are lower for minorities compared with whites. Healthcare providers should make special efforts to improve medication adherence among minorities.

Publication types

  • Evaluation Study
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • African Americans
  • Aged
  • Antihypertensive Agents / therapeutic use
  • Cholinesterase Inhibitors / therapeutic use
  • Cohort Studies
  • Dementia / complications*
  • Dementia / drug therapy
  • Dementia / ethnology
  • Drug Utilization
  • Ethnicity*
  • Female
  • Healthcare Disparities
  • Hispanic or Latino
  • Humans
  • Hypertension / complications*
  • Hypertension / drug therapy
  • Hypertension / ethnology
  • Male
  • Medication Adherence / ethnology*
  • Medication Adherence / statistics & numerical data*
  • Memantine / therapeutic use
  • Prevalence
  • Veterans
  • Whites


  • Antihypertensive Agents
  • Cholinesterase Inhibitors
  • Memantine