Chesterman Anna Katja Maria, Denney Michael, Afaq Shaikh, Moreno Melissa Stradley, Schwartz Thais M, Harrison Anil
University of Central Florida/HCA Healthcare GME Consortium at Florida West Hospital, 2120 E. Johnson Ave., Bldg. C, Ste 107, Pensacola, FL, 32514, USA.
Internal Medicine GME Core Faculty, Pensacola, USA.
J Racial Ethn Health Disparities. 2025 May 27. doi: 10.1007/s40615-025-02486-7.
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.
We investigated the likelihood of stroke among Blacks as compared to whites in the USA, focusing on the impact of different antihypertensive medications.
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.
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.
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.
中风仍然是全球残疾和死亡的主要原因，不同种族群体之间存在显著差异。与非西班牙裔白人相比，黑人首次中风的发病率更高，这可能受到高血压管理差异的影响。
我们调查了美国黑人与白人相比中风的可能性，重点关注不同抗高血压药物的影响。
我们使用来自43700名患者的数据进行了一项回顾性队列研究。描述性统计和二元逻辑回归评估了单一疗法抗高血压药物与首次入院时被诊断为中风的可能性之间的关系。种族被分析为效应修饰因子。
与白人相比，黑人被诊断为中风的可能性高1.40倍（95%置信区间[1.20, 1.64]，p < 0.0001）。抗高血压药物的类型对中风发病率有显著影响。入院前服用ACE-I或ARB的患者被诊断为中风的可能性是服用利尿剂患者的1.63倍（p = 0.0002，95%置信区间[1.23, 2.15]），服用钙通道阻滞剂（CCB）的患者被诊断为中风的可能性高1.80倍（p < 0.0001，95%置信区间[1.32, 2.46]）。尽管种族被分析为效应修饰因子，但未观察到种族与抗高血压药物使用之间的显著相互作用（p = 0.2998），这表明药物选择对不同种族群体中风风险的影响相似。
该研究证实，与白人相比，黑人中风的几率更高。抗高血压药物的选择显著影响中风风险，利尿剂在降低发病率方面显示出优于ACE-I、ARB和CCB的优势。这些发现表明，优化抗高血压治疗，特别是使用利尿剂，对于降低不同种族群体的中风风险可能至关重要。虽然本研究侧重于抗高血压药物的选择，但健康的其他社会决定因素，如社会经济地位和医疗保健可及性，值得在未来的研究中进一步调查。
