Disparities in hypertension and cardiovascular disease in blacks: The critical role of medication adherence

Abstract

Blacks are two to three times as likely as whites to die of preventable heart disease and stroke. Declines in mortality from heart disease have not eliminated racial disparities. Control and effective treatment of hypertension, a leading cause of cardiovascular disease, among blacks is less than in whites and remains a challenge. One of the driving forces behind this racial/ethnic disparity is medication nonadherence whose cause is embedded in social determinants. Eight practical approaches to addressing medication adherence with the potential to attenuate disparities were identified and include: (1) patient engagement strategies, (2) consumer-directed health care, (3) patient portals, (4) smart apps and text messages, (5) digital pillboxes, (6) pharmacist-led engagement, (7) cardiac rehabilitation, and (8) cognitive-based behavior. However, while data suggest that these strategies may improve medication adherence, the effect on ameliorating racial/ethnic disparities is not certain. This review describes the relationship between disparities and medication adherence, which likely plays a role in persistent disparities in cardiovascular morbidity and mortality.

Keywords: Adherence; Food and Drug Administration; blacks; cardiovascular disease; health disparities; hypertension; race/ethnicity.

Figure 1

Prevalence of hypertension among adults aged 18 and over, by sex and race and Hispanic origin: United States, 2011‐2014. ¹Significant difference from non‐Hispanic Asian. ²Significant difference from non‐Hispanic white. ³Significant difference from Hispanic. ⁴Significant difference from women in same race and Hispanic origin group. Note: Estimates are age‐adjusted by the direct method to the 2000 U.S. census population using age groups 18‐39, 40‐59, and over; see reference 9. Source: Centers for Disease Control and Prevention/National Center for Health Statistics, National Health and Nutrition Examination Survey, 2011‐2014. https://www.cdc.gov/nchs/data/databriefs/db220.pdf

Figure 2

Prevalence of controlled hypertension among adults with hypertension aged 18 and over, by sex and race and Hispanic origin: United States, 2011‐2014. ¹Significant difference from non‐Hispanic Asian. ²Significant difference from non‐Hispanic black. ³Significant difference from Hispanic. ⁴Significant difference from women in same race and Hispanic origin group. Note: Estimates are age‐adjusted by the direct method using computed weights based on the subpopulation of persons with hypertension in the 2001‐2012 National Health and Nutrition Examination Survey; see reference 7. Source: Centers for Disease Control and Prevention/National Center for Health Statistics, National Health and Nutrition Examination Survey, 2011‐2014. https://www.cdc.gov/nchs/data/databriefs/db220.pdf

Figure 3

Life expectancy at birth, by race and origin: US, 2013 and 2014. Note: Life expectancies are based on death rates that have been adjusted for race and Hispanic origin misclassification on death certificates (reference 1 in report). Arias E. United States life tables, 2011. National vital statistics reports; vol 64, no 11. Hyattsville, MD: National Center for Health Statistics; 2015. Source: Centers for Disease Control and Prevention/National Center for Health Statistics, National Vital Statistics System, Mortality Public domain. No permission needed. Access data table for Figure 1 at: http://www.cdc.gov/nchs/data/databriefs/db244.pdf

Figure 4

Disparities in person‐centered care. Panel (A) depicts racial differences in patients reporting poor communications with health provider, over a period of 10 years from 2002–2012. Panel (B) depicts differences in Hispanic patients reporting poor communications with health provider, based on income over a period of 10 years from 2002–2012. Source: Agency for Healthcare Research and Quality, Medical Expenditure panel survey, 2002–2012

Figure 5

National Vital Statistics System, US Census Bureau, 2008–2010. View more maps at the Interactive Atlas for Heart Disease and Stroke: http://nccd.cdc.gov/DHDSPAtlas/