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Multicenter Study
. 2017 Feb 23;6(3):e004758.
doi: 10.1161/JAHA.116.004758.

Effect of Race and Ethnicity on Antihypertensive Medication Utilization Among Women in the United States: Study of Women's Health Across the Nation (SWAN)

Elizabeth A Jackson  1 , Kristine Ruppert  2 , Carol A Derby  3 , Yinjuan Lian  2 , Genevieve Neal-Perry  4 , Laurel A Habel  5 , Ping G Tepper  2 , Siobán D Harlow  6 , Daniel H Solomon  7
Affiliations
Multicenter Study

Effect of Race and Ethnicity on Antihypertensive Medication Utilization Among Women in the United States: Study of Women's Health Across the Nation (SWAN)

Elizabeth A Jackson et al. J Am Heart Assoc. .

Abstract

Background: Antihypertensive medication use may vary by race and ethnicity. Longitudinal antihypertensive medication use patterns are not well described in women.

Methods and results: Participants from the Study of Women's Health Across the Nation (SWAN), a prospective cohort of women (n=3302, aged 42-52), who reported a diagnosis of hypertension or antihypertensive medication use at any annual visit were included. Antihypertensive medications were grouped by class and examined by race/ethnicity adjusting for potential confounders in logistic regression models. A total of 1707 (51.7%) women, mean age 50.6 years, reported hypertension or used antihypertensive medications at baseline or during follow-up (mean 9.1 years). Compared with whites, blacks were almost 3 times as likely to receive a calcium channel blocker (odds ratio, 2.92; 95% CI, 2.24-3.82) and twice as likely to receive a thiazide diuretic (odds ratio, 2.38; 95% CI, 1.93-2.94). Blacks also had a higher probability of reporting use of ≥2 antihypertensive medications (odds ratio, 1.95; 95% CI, 1.55-2.45) compared with whites. Use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and thiazide diuretics increased over time for all racial/ethnic groups. Contrary to our hypothesis, rates of β-blocker usage did not decrease over time.

Conclusions: Among this large cohort of multiethnic midlife women, use of antihypertensive medications increased over time, with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers becoming the most commonly used antihypertensive medication, even for blacks. Thiazide diuretic utilization increased over time for all race/ethnic groups as did use of calcium channel blockers among blacks; both patterns are in line with guideline recommendations for the management of hypertension.

Keywords: disparities; hypertension; medication; race/ethnicity; women.

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Figures

Figure 1
Figure 1
Consort diagram. CVD indicates cardiovascular disease; HTN, hypertension; SWAN, Study of Women's Health Across the Nation.
Figure 2
Figure 2
Antihypertensive medications over time by race/ethnicity. ACE indicates angiotensin‐converting enzyme inhibitor; ARB, angiotensin receptor blocker; BB, β‐blocker; CCB, calcium channel blocker; THIAZIDE, thiazide diuretic.
See this image and copyright information in PMC

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