Race/Ethnic Differences in Atherosclerotic Cardiovascular Disease Risk Factors Among Patients with Hypertension: Analysis from 143 primary care clinics

Am J Hypertens. 2021 Apr 20;hpab053. doi: 10.1093/ajh/hpab053. Online ahead of print.

Abstract

Background: While it is known that sex and race/ethnic disparities persist for atherosclerotic cardiovascular disease (ASCVD), disparities in risk factor control have not been well-described in primary care where ASCVD can be prevented.

Methods: Adult patients with a hypertension diagnosis without ASCVD were included in this analysis of electronic health records from a large US healthcare system from 2018. Patients were categorized based on risk factor control defined as blood pressure <130/80 mmHg; statin prescription among patients with indications, HbA1c of <7%, and not smoking. Multivariable Poisson regressions were developed to explore associations with race/ethnicity. Results are presented as relative risk (RR), 95% confidence intervals (CI).

Results: Among 5,227 patients, 55.8% women and 60.0% men had uncontrolled blood pressure, 47.3% women and 46.4% men with statin therapy indication did not have a prescription, 34.9% women and 40.9% men had uncontrolled HbA1c values, and 9.3% women and 13.7% men were smokers. African Americans were more likely to have uncontrolled blood pressure (women: RR1.18, 95%CI 1.07-1.30; men: RR1.20, 95%CI 1.05-1.34) and more likely to lack a statin prescription (women: RR1.23, 95%CI 1.05-1.45; men: RR1.25, 95%CI 1.03-1.51) compared to Caucasians. Differences in HbA1c control were not statistically significant among Hispanic/Latino compared to Caucasians (women: RR1.28, 95%CI 0.86-1.90; men: RR1.20, 95%CI 0.72-1.97).

Conclusions: Disparities in controlling ASCVD risk factors in primary care persist and were not fully explained by demographic or clinical characteristics. Monitoring changes in disparities is important to ensure equity as interventions to prevent ASCVD in primary care are developed and implemented.

Keywords: CVD; clinical practice guidelines; disparities; hypertension; risk factor control.