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GERIATRICS

Ethnic Differences in Antihypertensive Medication Use in the Elderly

Assistant Professor and Director, Memory Loss Clinics; Associate Director, University of Texas Medical Branch Geriatric Fellowship Training Program, Sealy Center on Aging, Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX

Yong-Fang Kuo, PhD

Assistant Professor, Sealy Center on Aging, University of Texas Medical Branch

Joel A Salazar, MD

Fellow in Geriatrics, Sealy Center on Aging, University of Texas Medical Branch

Shiva Satish, MD

Associate Professor, Sealy Center on Aging, University of Texas Medical Branch

James S Goodwin, MD

Professor of Medicine, Chief of Geriatrics Division, Director of Sealy Center on Aging, University of Texas Medical Branch

Reprints: Mukaila A Raji MD MSc, Sealy Center on Aging, Department of Internal Medicine, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-0460, fax 409/772-6931, muraji{at}utmb.edu

BACKGROUND: Determining the optimal treatment for hypertension in very old patients requires better understanding of interethnic differences in patterns and predictors of antihypertensive drug use in this population.

OBJECTIVE: To investigate interethnic variations in antihypertensive drug use in a tri-ethnic sample of community-dwelling adults aged 77 years.

METHODS: We performed a cross-sectional study of non-Hispanic white, black, and Hispanic adults 77 years old residing in Galveston County, TX. In-home interviews in 1997 and 1998 assessed blood pressures and antihypertensive medication use in 281 subjects who reported having hypertension or who had a systolic blood pressure 140 mm Hg and/or diastolic blood pressure 90 mm Hg.

RESULTS: Of the population evaluated, 62.9% of non-Hispanic whites, 60.2% of blacks, and 45.2% of Hispanics with hypertension were on antihypertensive medications (p < 0.027 across the ethnic groups). After adjusting for age, gender, years of education, household income, Medicaid insurance, number of physician visits, and cognitive function, Hispanic ethnicity, unlike black ethnicity, continued to be significantly associated with lower use of antihypertensive drugs compared with non-Hispanic whites (OR 0.41; 95% CI 0.19 to 0.90). Characteristics associated with the lower use of antihypertensive drugs included older age and low income in whites, poor cognition and infrequent physician visits in blacks, and lack of Medicaid insurance in Hispanics.

CONCLUSIONS: In the elderly, Hispanic ethnicity, unlike black ethnicity, is significantly associated with lower use of antihypertensive drug therapy compared with non-Hispanic white ethnicity, adjusting for relevant sociodemographic and health factors.

Key Words: elderly, ethnicity, hypertension

Published Online, December 15, 2003. www.theannals.com, DOI 10.1345/aph.1D224

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