Racial/Ethnic Disparities in Use of Angiotensin II Receptor Type 2/4 Stimulatory Vs. Inhibitory Antihypertensive Among Hypertensive Adults in the USA

Eissa Jafari; Sumaya Abuloha; Alaa Alshehri; Islam Eljilany; Rupal Aroza; Jingchuan Guo; Hui Shao

doi:10.1007/s40615-024-01970-w

Racial/Ethnic Disparities in Use of Angiotensin II Receptor Type 2/4 Stimulatory Vs. Inhibitory Antihypertensive Among Hypertensive Adults in the USA

J Racial Ethn Health Disparities. 2024 Mar 18. doi: 10.1007/s40615-024-01970-w. Online ahead of print.

Authors

Eissa Jafari^#^{1

2}, Sumaya Abuloha^#^{3

4}, Alaa Alshehri^#^{3

5}, Islam Eljilany^#^{1

6}, Rupal Aroza^{3

7}, Jingchuan Guo^{3

8}, Hui Shao^{9

10

11}

Affiliations

¹ Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA.
² Department of Pharmacy Practice, College of Pharmacy, Jazan University, Jazan, Kingdom of Saudi Arabia.
³ Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA.
⁴ Department of Clinical Pharmacy and Pharmacy Practice, College of Pharmacy, Yarmouk University, Irbid, Jordan.
⁵ Department of Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia.
⁶ Department of Cutaneous Oncology and Immunology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA.
⁷ Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Kentucky, Lexington, KY, USA.
⁸ Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, FL, USA.
⁹ Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA. Hui.Shao@emory.edu.
¹⁰ Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA. Hui.Shao@emory.edu.
¹¹ Emory Global Diabetes Research Center of Woodruff Health Sciences Center, Emory University, Atlanta, GA, USA. Hui.Shao@emory.edu.

^# Contributed equally.

PMID: 38498117
DOI: 10.1007/s40615-024-01970-w

Abstract

Objectives: Studies showed angiotensin II type 2 receptor/angiotensin II type 4 receptor (AT2R/AT4R) stimulatory antihypertensive was associated with a lower risk of dementia and cognitive impairment compared to the inhibitory one. This study aimed to identify the racial and ethnic differences in using these agents among the USA adults with hypertension.

Methods: A cross-sectional study was conducted using data from the Medical Expenditure Panel Survey (MEPS, 2016-2019). Individuals with a diagnosis of hypertension or self-reported hypertension and without dementia or Alzheimer's disease diagnosis were included in the analysis. We applied two multivariable logistic regressions to compare racial/ethnic differences in AT2R/AT4R stimulatory antihypertensive use and AT2R/AT4R inhibitory antihypertensive use, adjusting for covariates.

Results: Twenty-four thousand five hundred eighty-one individuals with hypertension and without dementia or Alzheimer's disease were identified. Among non-Hispanic Whites, 72.39% were using AT2R/AT4R inhibitory antihypertensive agents, vs. 66.97% using AT2R/AT4R stimulatory antihypertensive agents. In contrast, both non-Hispanic Black and Asian Americans were using more AT2R/AT4R stimulatory agents than inhibitory ones (16.40% vs. 12.16% and 4.79% vs. 3.43%, respectively). Compared to non-Hispanic White, non-Hispanic Black (OR 1.980, 95% CI 1.839-2.132) and non-Hispanic Asian Americans (OR 1.545, 95% CI 1.356-1.761) were significantly associated with higher odds of prescribing AT2R/AT4R stimulatory agents, while Hispanics (OR 0.744, 95% CI 0.685-0.808) were associated with lower odds of prescribing AT2R/AT4R inhibitory agents compared to non-Hispanic Whites.

Conclusions: The results showed that the high-dementia risk populations like non-Hispanic Black and Asian American races are proportionally prescribed with higher use of low-dementia risk antihypertensive agents, compared to non-Hispanic Whites.

Keywords: Antihypertensives; Dementia; Health disparities; Hypertension.