Eastwood Sophie V, Hughes Alun D, Tomlinson Laurie, Mathur Rohini, Smeeth Liam, Bhaskaran Krishnan, Chaturvedi Nishi
MRC Unit for Lifelong Health and Aging at UCL, 1-19 Torrington Place, Floor 5, London, WC1E 7HB, UK.
Electronic Health Records Group, London School of Hygiene and Tropical Medicine, 2nd floor, Keppel Street, London, WC1E 7HT, UK.
Lancet Reg Health Eur. 2022 Dec 5;25:100557. doi: 10.1016/j.lanepe.2022.100557. eCollection 2023 Feb.
In the UK, previous work suggests ethnic inequalities in hypertension management. We studied ethnic differences in hypertension management and their contribution to blood pressure (BP) control.
We conducted a cohort study of antihypertensive-naïve individuals of European, South Asian and African/African Caribbean ethnicity with a new raised BP reading in UK primary care from 2006 to 2019, using the Clinical Practice Research Datalink (CPRD). We studied differences in: BP re-measurement after an initial hypertensive BP, antihypertensive initiation, BP monitoring, antihypertensive intensification, antihypertensive persistence/adherence and BP control one year after antihypertensive initiation. Models adjusted for socio-demographics, BP, comorbidity, healthcare usage and polypharmacy (plus antihypertensive class, BP monitoring, intensification, persistence and adherence for BP control models).
A total of 731,506 (93.5%), 30,379 (3.9%) and 20,256 (2.6%) people of European, South Asian and African/African Caribbean ethnicity were studied. Hypertension management indicators were similar or more favourable for South Asian than European groups (OR/HR [95% CI] in fully-adjusted models of BP re-measurement: 1.16 [1.09, 1.24]), antihypertensive initiation: 1.49 [1.37, 1.62], BP monitoring: 0.97 [0.94, 1.00] and antihypertensive intensification: 1.10 [1.04, 1.16]). For people of African/African Caribbean ethnicity, BP re-measurement rates were similar to those of European ethnicity (0.98 [0.91, 1.05]), and antihypertensive initiation rates greater (1.48 [1.32, 1.66]), but BP monitoring (0.91 [0.87, 0.95]) and intensification rates lower (0.93 [0.87, 1.00]). Persistence and adherence were lower in South Asian (0.48 [0.45, 0.51] and 0.51 [0.47, 0.56]) and African/African Caribbean (0.38 [0.35, 0.42] and 0.39 [0.36, 0.43]) than European groups. BP control was similar in South Asian and less likely in African/African Caribbean than European groups (0.98 [0.90, 1.06] and 0.81 [0.74, 0.89] in age, gender and BP adjusted models). The latter difference attenuated after adjustment for persistence (0.91 [0.82, 0.99]) or adherence (0.92 [0.83, 1.01]), and was absent for antihypertensive-adherent people (0.99 [0.88, 1.10]).
We demonstrate that antihypertensive initiation does not vary by ethnicity, but subsequent BP control was notably lower among people of African/African Caribbean ethnicity, potentially associated with being less likely to remain on regular treatment. A nationwide strategy to understand and address differences in ongoing management of people on antihypertensives is imperative.
Diabetes UK.
在英国，先前的研究表明高血压管理存在种族不平等现象。我们研究了高血压管理中的种族差异及其对血压控制的影响。
我们利用临床实践研究数据链（CPRD），对2006年至2019年在英国初级医疗中首次测量血压升高且未服用过抗高血压药物的欧洲、南亚和非洲/非洲加勒比裔个体进行了队列研究。我们研究了以下方面的差异：初次高血压血压测量后的血压复测、抗高血压药物起始治疗、血压监测、抗高血压药物强化治疗、抗高血压药物持续性/依从性以及抗高血压药物起始治疗一年后的血压控制情况。模型对社会人口统计学、血压、合并症、医疗保健使用情况和联合用药进行了调整（血压控制模型还对抗高血压药物类别、血压监测、强化治疗、持续性和依从性进行了调整）。
共研究了731,506名（93.5%）欧洲裔、30,379名（3.9%）南亚裔和20,256名（2.6%）非洲/非洲加勒比裔个体。南亚人群的高血压管理指标与欧洲人群相似或更优（在完全调整模型中，血压复测的比值比/风险比[95%置信区间]：1.16[1.09, 1.24]），抗高血压药物起始治疗：1.49[1.37, 1.62]，血压监测：0.97[0.94, 1.00]，抗高血压药物强化治疗：1.10[1.04, 1.16]）。对于非洲/非洲加勒比裔人群，血压复测率与欧洲裔人群相似（0.98[0.91, 1.05]），抗高血压药物起始治疗率更高（1.48[1.32, 1.66]），但血压监测率（0.91[0.87, 0.95]）和强化治疗率较低（0.93[0.87, 1.00]）。南亚裔（0.48[0.45, 0.51]和0.51[0.47, 0.56]）和非洲/非洲加勒比裔（0.38[0.35, 0.42]和0.39[0.36, 0.43]）的持续性和依从性低于欧洲裔人群。南亚裔和非洲/非洲加勒比裔的血压控制情况与欧洲裔人群相似，非洲/非洲加勒比裔的血压控制可能性低于欧洲裔人群（在年龄、性别和血压调整模型中分别为0.98[0.90, 1.06]和0.81[0.74, 0.89]）。在调整持续性（0.91[0.82, 0.99]）或依从性（0.92[0.83, 1.01]）后，后一种差异有所减弱，而在坚持服用抗高血压药物的人群中则不存在这种差异（0.99[0.88, 1.10]）。
我们证明了抗高血压药物起始治疗不因种族而异，但非洲/非洲加勒比裔人群的后续血压控制明显较低，这可能与他们不太可能坚持常规治疗有关。制定一项全国性战略来了解和解决抗高血压药物治疗患者持续管理中的差异势在必行。
英国糖尿病协会。
