Abstract Body: Introduction
The burden of hypertension is not felt uniformly across the population, with non-Hispanic Black (NHB) adults experiencing the highest rates of hypertension-attributable mortality. The 2017 AHA guidelines recommend calcium channel blockers (CCBs) and thiazide-like diuretics as initial medications for NHB patients, with ACE/ARBs a first line recommendation for other populations. It remains unclear to what degree providers adhere to these race-specific recommendations.
Methods
We examined electronic health record data of all hypertensive adults (first blood pressure >140/90 mmHg) starting antihypertensive therapy between 1/2013-12/2022. We excluded patients with a diagnosis of CAD/MI, diabetes, stroke, heart failure, or CKD. We specifically identified the order in which each antihypertensive medication class was prescribed.
Results
We identified a total of n=26,862 patients, of whom n=4015 (14.95%) were NHB. CCBs were the most prescribed first line antihypertensive agent for NHBs, followed by ACE/ARBs, then diuretics. By comparison, for all other patients, ACE/ARBs were the most prescribed first agent, followed by CCBs, then beta-blockers (Figure 1A-B). Over the study period, initial use of CCBs increased and diuretic use decreased for both groups (Figure 1C-D).
Conclusions
Following guidelines, the most frequently prescribed first line antihypertensive agents were CCBs and ACE/ARBs for NHB and non-NHB populations, respectively, with decreasing diuretic use. The identified patterns increased over the study period, indicating an overuse of ACE/ARB and underuse of diuretics among NHB patients.