Division of General Internal Medicine, Department of Medicine, Georgetown University Hopsital, Washington DC, USA.
J Gerontol A Biol Sci Med Sci. 2012 Nov;67(11):1253-8. doi: 10.1093/gerona/gls106. Epub 2012 Apr 10.
Cardiovascular disease is the main cause of death in older adults. Uncontrolled blood pressure is an important risk factor for cardiovascular disease. African Americans have poorer blood pressure control than non-Hispanic whites. Little is known about whether this difference persists in older ages or the factors that contribute to this racial gap.
Data were obtained from participants of the Chicago Health and Aging Program. Blood pressure control was defined according to JNC-7 criteria. Univariate chi-square analyses were used to determine racial differences in hypertension and blood pressure control, whereas sequential multivariate logistic regression models were used to determine the effect of race on blood pressure control.
African Americans had a higher prevalence of hypertension (74% vs 63%; p < .001), higher awareness of hypertension (81% vs 72%; p < .001), and poorer blood pressure control (45% vs 51%, p < .001) than non-Hispanic whites. Racial differences in blood pressure control persisted after adjustment for socioeconomic status, medical conditions, obesity, and use of antihypertensive medications (odds ratio = 0.84, 95% confidence interval = 0.70-0.94). From 1993 to 2008, blood pressure control improved more among non-Hispanic whites than among African Americans.
Racial differences in blood pressure control in older adults were not explained by socioeconomic status. The racial disparity in the prevalence and control of hypertension remained consistent for older hypertensive individuals eligible for Medicare. Although the rates of hypertension control improved for both racial groups, the improvement was greater among whites, thus widening the gap in this older population at high risk for cardiovascular disease.
心血管疾病是老年人的主要死因。未得到控制的血压是心血管疾病的一个重要危险因素。非西班牙裔美国黑人的血压控制情况不如非西班牙裔白人。对于这种差异是否在老年时仍然存在，或者导致这种种族差距的因素是什么，人们知之甚少。
数据来自芝加哥健康与老龄化项目的参与者。根据 JNC-7 标准，血压控制情况被定义。采用单变量卡方分析来确定高血压和血压控制方面的种族差异，而采用逐步多元逻辑回归模型来确定种族对血压控制的影响。
非西班牙裔美国黑人的高血压患病率（74%比 63%；p <.001）、高血压知晓率（81%比 72%；p <.001）和血压控制率（45%比 51%；p <.001）均高于非西班牙裔白人。调整社会经济地位、医疗状况、肥胖和使用抗高血压药物后，血压控制方面的种族差异仍然存在（比值比=0.84，95%置信区间=0.70-0.94）。从 1993 年到 2008 年，非西班牙裔白人的血压控制情况改善幅度大于非西班牙裔黑人。
在老年人中，血压控制方面的种族差异不能用社会经济地位来解释。在有资格参加医疗保险的老年高血压患者中，高血压的患病率和控制率方面的种族差异仍然存在。尽管两个种族群体的高血压控制率都有所提高，但白人的提高幅度更大，从而在这个心血管疾病高危的老年人群体中扩大了差距。
