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Review
. 2017 Oct;19(10):1015-1024.
doi: 10.1111/jch.13089. Epub 2017 Aug 30.

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

Keith C Ferdinand  1 , Kapil Yadav  1 , Samar A Nasser  2 , Helene D Clayton-Jeter  3 , John Lewin  4 , Dennis R Cryer  5 , Fortunato Fred Senatore  6
Affiliations
Review

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

Keith C Ferdinand et al. J Clin Hypertens (Greenwich). 2017 Oct.

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.

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Conflict of interest statement

Dr Cryer serves as consultant for Esperion Therapeutics. Dr Ferdinand received a grant from Boehringer Ingleheim and serves as consultant for Amgen, Sanofi, Boehringer Ingleheim, Quantum Genomics, Novartis, and Eli Lily. Drs Senatore, Clayton‐Jeter, Lewin, Nasser, and Yadav have nothing to disclose.

Figures

Figure 1
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
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
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
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
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/
See this image and copyright information in PMC

Comment in

References

    1. Ritchey M, Chang A, Powers C, et al. Vital signs: disparities in antihypertensive medication nonadherence among Medicare part D beneficiaries—United States, 2014. MMWR Morb Mortal Wkly Rep. 2016;65:967‐976. - PubMed
    1. Flack JM, Sica DA, Bakris G, et al. International Society on Hypertension in Blacks. Management of high blood pressure in blacks: an update of the International Society on Hypertension in Blacks consensus statement. Hypertension. 2010;56:780‐800. - PubMed
    1. Whelton PK, Einhorn PT, Muntner P, et al. Research needs to improve hypertension treatment and control in African Americans. Hypertension. 2016;68:1066‐1072. - PMC - PubMed
    1. Yoon SS, Carroll MD, Fryar CD. Hypertension prevalence and control among adults: United States, 2011–2014. NCHS Data Brief. 2015;(220):1‐8. - PubMed
    1. Havranek EP, Mujahid MS, Barr DA, et al. Social determinants of risk and outcomes for cardiovascular disease. Circulation. 2015;132:873‐898. - PubMed

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