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. 2025 May 27.
doi: 10.1007/s40615-025-02486-7. Online ahead of print.

Probability of Stroke in Blacks and Non-Hispanic Whites Treated with ACE-I, ARBs, and Other Antihypertensives

Anna Katja Maria Chesterman  1 , Michael Denney  2 , Shaikh Afaq  2   3 , Melissa Stradley Moreno  4 , Thais M Schwartz  5 , Anil Harrison  6
Affiliations

Probability of Stroke in Blacks and Non-Hispanic Whites Treated with ACE-I, ARBs, and Other Antihypertensives

Anna Katja Maria Chesterman et al. J Racial Ethn Health Disparities. .

Abstract

Background: Stroke remains a leading cause of disability and death worldwide, with significant disparities between racial groups. Blacks have a higher incidence of first-time stroke compared to non-Hispanic whites, potentially influenced by differences in hypertension management.

Objective: We investigated the likelihood of stroke among Blacks as compared to whites in the USA, focusing on the impact of different antihypertensive medications.

Methods: We conducted a retrospective cohort study using data from 43,700 patients. Descriptive statistics and binary logistic regression assessed the relationship between antihypertensives as monotherapy and the likelihood of being diagnosed with a stroke on index admission. Race was analyzed as an effect modifier.

Results: Blacks were 1.40 times more likely to be diagnosed with a stroke compared to whites (95% CI [1.20, 1.64], p < 0.0001). The type of antihypertensive medication significantly impacted stroke incidence. Patients taking ACE-I or ARBs prior to admission were 1.63 times more likely to be diagnosed with a stroke compared to those taking diuretics (p = 0.0002, 95% CI [1.23, 2.15]), and those taking calcium channel blockers (CCBs) were 1.80 times more likely (p < 0.0001, 95% CI [1.32, 2.46]). Although race was analyzed as an effect modifier, no significant interaction between race and antihypertensive use was observed (p = 0.2998), suggesting that medication choice affects stroke risk similarly across racial groups.

Conclusion: The study confirms that Blacks have higher odds of stroke compared to whites. The choice of antihypertensive significantly influences stroke risk, with diuretics showing superiority over ACE-I, ARBs, and CCBs in reducing incidence. These findings suggest that optimizing antihypertensive therapy, particularly the use of diuretics, may be crucial in mitigating stroke risk across different racial groups. While this study focuses on antihypertensive choice, additional social determinants of health, such as socioeconomic status and healthcare access, warrant further investigation in future studies.

Keywords: ACE-I; ACE-Inhibitors; ARBs; African-Americans; Angiotensin II Receptor Blockers; Antihypertensive Therapy; Blacks; Caucasians; Cerebrovascular Event; Clinical Outcomes; Ethnic Differences Comparative Analysis; Hypertension; Racial Disparities; Stroke; Treatment Efficacy.

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Conflict of interest statement

Declarations. Ethics Approval: Our study was determined to be exempt or excluded from Institutional Review Board (IRB) oversight in accordance with current regulations and institutional policy. Our internal HCA Healthcare reference number for this determination is 2023–228. Consent to Participate: Not applicable. Consent for Publication: Not applicable. Conflict of interest: The authors have no relevant financial or non-financial interests to disclose.

References

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