Racial Disparity in Hypertension Control: Tallying the Death Toll
Racial Disparity in Hypertension Control: Tallying the Death Toll
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DOI：
10.1370/afm.873
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发表时间：
2008-11-01
影响因子：
4.4
通讯作者：
Holt, Kathleen
中科院分区：
文献类型：
--
作者：
Fiscella, Kevin;Holt, Kathleen
目的美国黑人高血压患者的血压控制比白人高血压患者差，但这种差异对黑人成年人死亡率的影响尚不清楚。我们评估了被诊断为高血压的白人和黑人成年人在收缩压(SBP)控制方面的差异，并测量了这种差异对黑人心脑血管死亡率的影响。方法根据参加1999-2002年国家健康和营养检查调查的白人和黑人成年人的SBP测量，我们模拟了黑人平均SBP降低到白人的死亡率变化。我们估计黑人高血压患者死亡率的数据来源是对SBP观察性研究的荟萃分析；我们降低死亡率的数据来源是SBP治疗试验的荟萃分析。结果最终获得SBP测量的参与者样本包括1,545名黑人成年人和1,335名白人成年人。黑人高血压患者的平均SBP比成年黑人人群高约6 mm Hg，比白人高血压患者高7 mm Hg。在高血压人群中，黑人的平均SBP下降到白人的水平，黑人每年死于心脏病的人数将减少5480人，死于中风的人数将减少2190人。结论消除成人高血压患者在血压控制方面的种族差异将大大减少黑人死于心脏病和中风的人数。初级保健临床医生在处理黑人患者的高血压时应该特别勤奋。Ann Fam Med 2008；6：497-502。DOI：10.1370/afm.873。
PURPOSE Black Americans with hypertension have poorer blood pressure control than their white counterparts, but the impact of this disparity on mortality among black adults is not known. We assessed differences in systolic blood pressure (SBP) control among white and black adults with a diagnosis of hypertension, and measured the impact of that difference on cardiovascular and cerebrovascular mortality among blacks.METHODS Using SBP measurements from white and black adults participating in the National Health and Nutrition Examination Survey, 1999-2002, we modeled changes in mortality rates resulting from a reduction of mean SBP among blacks to that of whites. Our data source for mortality estimates of blacks with hypertension was a meta-analysis of observational studies of SBP; our data source for reduction in mortality rates was a meta-analysis of SBP treatment trials.RESULTS The final sample of participants for whom SBP measurements were available included 1,545 black adults and 1,335 white adults. The mean SBP among blacks with hypertension was approximately 6 mm Hg higher than that for the total adult black population and 7 mm Hg higher than that for whites with hypertension. Within the hypertensive population, a reduction in mean SBP among blacks to that of whites would reduce the annual number of deaths among blacks from heart disease by 5,480 and from stroke by 2,190.CONCLUSIONS Eliminating racial disparity in blood pressure control among adults with hypertension would substantially reduce the number of deaths among blacks from both heart disease and stroke. Primary care clinicians should be particularly diligent when managing hypertension in black patients. Ann Fam Med 2008;6:497-502. DOI: 10.1370/afm.873.