Department of Neurology (B.S., C.M.L., D.A.L.), University of Michigan, Ann Arbor.
Department of Neurology (B.S., P.B.G.), Northwestern University, Chicago, IL.
Stroke. 2024 Aug;55(8):2034-2044. doi: 10.1161/STROKEAHA.124.046877. Epub 2024 Jul 22.
Recent hypertension guidelines for the general population have included race-specific recommendations for antihypertensives, whereas current stroke-specific recommendations for antihypertensives do not vary by race. The impact of these guidelines on antihypertensive regimen changes over time, and if this has varied by prevalent stroke status, is unclear.
The use of antihypertensive medications was studied cross-sectionally among self-identified Black and White participants, aged ≥45 years, with and without history of stroke, from the REGARDS study (Reasons for Geographic and Racial Differences in Stroke). Participants completed an in-home examination in 2003-2007 (visit 1) with/without an examination in 2013-2016 (visit 2). Stratified by prevalent stroke status, logistic regression mixed models examined associations between antihypertensive class use for visit 2 versus visit 1 and Black versus White individuals with an interaction adjusted for demographics, socioeconomic status, and vascular risk factors/vital signs.
Of 17 244 stroke-free participants at visit 1, Black participants had greater adjusted odds of angiotensin-converting enzyme inhibitor usage than White participants (odds ratio [OR], 1.51 [95% CI, 1.30-1.77]). This difference was smaller in the 7476 stroke-free participants at visit 2 (OR, 1.16 [95% CI, 1.08-1.25]). In stroke-free participants at visit 1, Black participants had lower odds of calcium channel blocker (CCB) usage than White participants (OR, 0.47 [95% CI, 0.41-0.55]), but CCB usage did not differ significantly between Black and White stroke-free participants at visit 2 (OR, 1.02 [95% CI, 0.95-1.09]). Among 1437 stroke survivor participants at visit 1, Black participants had lower odds of CCB use than White participants (OR, 0.34 [95% CI, 0.26-0.45]). In 689 stroke survivor participants at visit 2, CCB use did not differ between Black and White participants (OR, 0.80 [95% CI, 0.61-1.06]).
Racial differences in the use of guideline-recommended antihypertensives decreased between 2003-2007 and 2013-2016 in stroke-free individuals. In stroke survivors, racial differences in CCB usage narrowed over the time periods. These findings suggest there is still a mismatch between race-specific hypertension guidelines and recent clinical practice.
最近的普通人群高血压指南包括了针对抗高血压药物的种族特异性建议，而当前针对抗高血压药物的卒中特异性建议则没有因种族而有所不同。这些指南对降压方案随时间的变化的影响，以及如果这种变化因现患卒中状态而有所不同，目前尚不清楚。
这项研究在 REGARDS 研究（地理和种族差异导致的卒中原因）中，对自我认定为年龄≥45 岁的黑人和白人参与者进行了横断面研究，这些参与者有或没有卒中病史。参与者在 2003-2007 年（第 1 次就诊）完成了一次家庭检查，在 2013-2016 年（第 2 次就诊）完成了一次家庭检查或没有完成。根据现患卒中状态进行分层，使用逻辑回归混合模型，调整了人口统计学、社会经济地位以及血管风险因素/生命体征后，分析了第 2 次就诊时与第 1 次就诊时抗高血压药物类别使用情况与黑人参与者和白人参与者之间的关联，并进行了交互作用的调整。
在第 1 次就诊时的 17244 例无卒中参与者中，黑人参与者使用血管紧张素转换酶抑制剂的校正比值比（OR）高于白人参与者（1.51 [95%可信区间，1.30-1.77]）。在第 2 次就诊时的 7476 例无卒中参与者中，这种差异较小（OR，1.16 [95%可信区间，1.08-1.25]）。在第 1 次就诊时的无卒中参与者中，黑人参与者使用钙通道阻滞剂（CCB）的校正比值比（OR）低于白人参与者（0.47 [95%可信区间，0.41-0.55]），但在第 2 次就诊时，黑人参与者和白人参与者之间 CCB 的使用差异无统计学意义（OR，1.02 [95%可信区间，0.95-1.09]）。在第 1 次就诊时的 1437 例卒中幸存者参与者中，黑人参与者使用 CCB 的校正比值比（OR）低于白人参与者（0.34 [95%可信区间，0.26-0.45]）。在第 2 次就诊时的 689 例卒中幸存者参与者中，黑人参与者和白人参与者之间 CCB 的使用差异无统计学意义（OR，0.80 [95%可信区间，0.61-1.06]）。
在无卒中个体中，2003-2007 年至 2013-2016 年间，指南推荐的抗高血压药物使用的种族差异有所减少。在卒中幸存者中，CCB 使用的种族差异在这两个时间段都有所缩小。这些发现表明，种族特异性高血压指南与最近的临床实践之间仍然存在不匹配。
