| Hypertension is a major contributor to morbidity, mortality, and medical costs in the United States. African Americans (AAs) have the highest prevalence of hypertension in the world, exhibiting at least twice the rate for Caucasians in almost every age and sex group. AAs are also at higher risk for complications from hypertension than Caucasians. While several factors have been proposed as accounting for those differences, there is no consensus on which factors may be responsible; the reasons for disparities in hypertension control in AAs are complex, and need further investigation. This study explored relationships between multiple factors to identify how they might contribute to disparities in hypertension control between AAs and Caucasians. A secondary analysis of data from 1,287 municipal employees participating in City of Birmingham Good Health Program health screenings was used. All participants reporting either a history of hypertension or taking antihypertensive medication were included. Predictors included race, antihypertensive medication, work shift, stress, job and life satisfaction, physical activity, smoking, salty food and alcohol intake, frequency of eating out, high fat food intake, BMI, and waist circumference. The response variable was hypertension control (blood pressure less than 140/90), and covariates included age, gender, marital status, educational level, and income. Multiple logistic regression was used to identify variables associated with hypertension control and with taking antihypertensive medication, and chi 2 was employed to test for differences in class of antihypertensive medication. The participants were predominantly AA (72%), male (72%), and obese (61%), with a mean age of 48. Fifty two percent had controlled hypertension. After controlling for covariates, AAs had a one third lower odds for controlled hypertension than Caucasians. This relationship held even in participants taking medication. Other variables independently associated with controlled hypertension included income and gender. AAs were no more likely than Caucasians to take antihypertensive medications. Independent predictors of taking antihypertensive medications included income, gender, and age. Though less likely to have controlled hypertension, AAs were no more likely to be prescribed combination antihypertensive therapy. |
