American Heart Association President, Mitchell S. V. Elkind, M.D., MS, FAHA, FAAN, professor of neurology and epidemiology at Columbia University Vagelos College of Physicians and Surgeons and attending neurologist at NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY.
Offering perspective on AHA Scientific Sessions 2020 Presentation MP269
copyright American Heart Association 2020

"This study represents further evidence of disparities in the hypertension. We've known for a long time that black people are at increased risk of high blood pressure and cardiovascular disease, particularly stroke. Hypertension is the most important risk factor for stroke and control of blood pressure is very important and has been lower than ideal in certain race ethnic groups, particularly black Americans. What we haven't known though, is the mechanisms for this and what this study addresses is why blood pressure levels may be less well controlled in African-Americans. The investigators looked at a large population of patients being treated and actual practices in San Francisco, and they found that the major reason for lacking adequate blood pressure control was a failure to intensify treatment. By intensification of treatment, what they mean is that people did not have their number of blood pressure medications increased or the dose of those medications increased. And they found that the failure to intensify treatment was the leading cause for disparity or for worse blood pressure control among blacks. Interestingly, they also found that the intensification of treatment was responsible for improved blood pressure control among Asian-Americans. So this study really provides evidence that there are differences in levels of blood pressure control according to race ethnic group, and that the increases in treatment either increasing dose or increasing the number of medications was an important reason for that. The reason for the lack of blood pressure control in black people, for example was not due to them missing their clinic appointment visits which may have been a reason that some people previously thought that blood pressure control was worse in a certain groups. That doesn't seem to be the case."