20 Disparities in Resistant Hypertension Resistant hypertension is more common in people who are Black, male and/or older age.5-Patient Characteristics Non-Hispanic Black adults, compared to non-Hispanic white adults, have higher rates of hypertension and lower rates of hypertension control, as well as treatment intensification.19-Medication and Treatment Considerations Race is not a biological construct for disparities in hypertension and other CVD outcomes. Race and ethnicity are factors within the context of socioeconomic, environmental and systemic issues such as structural racism.17-Race and Ethnicity The hypertension burden in Black Americans is driven not by identifiable genetic factors but by social determinants of health (SDOH). Factors such as disparate rates of unemployment, family income, food insecurity, lower educational levels, lack of private health insurance and not living with a spouse or partner are significantly and independently associated with premature death. After adjusting for SDOH, the increased risk of early death for Black adults compared to white adults disappears, according to one study.20-Non-Pharmcologic Approaches A recent study identified three common health barriers (another term for SDOH) as key factors in hypertension outcomes: health literacy, patient activation and financial stress.21-Introduction Black patients made up one-third of the cohort but accounted for nearly half of patients with two or more health barriers.21-Results Patients who had no health barriers had greater BP control than those with one or more health barriers regardless of race. However, there was no difference in BP control between Black and white patients who had two or more health barriers.21-Results, Discussion Access to health care, socioeconomic status, limited access to healthy foods, acculturation, health literacy and language are important drivers of SDOH among underrepresented racial and ethnic groups.19-Conclusions Disparities in RH can and should be addressed. SDOH should always be considered in clinical assessments. Future efforts should focus on community outreach and tailored approaches that address barriers to hypertension control,7-Highlights including equitable access to care. 17-Conclusions Evidence-based medicine is the standard of care for all patients regardless of their race/ethnicity, sex/gender, socioeconomic status, geography or ability/disability. 20-Conclusion Patients with hypertension who track their own BP using ambulatory or home BP monitoring rather than in-office measurement are more engaged in their own care and may show increased adherence. Use of 24-hour ABPM or home BP monitoring in place of office BP monitoring can help with confirmation and management of hypertension.23-Discussion, Conclusion Simplify treatment regimens as much as possible to ease medication burden and improve adherence.23-Conclusion Encourage patients to build their social networks and expand their social contacts. For example, the Jackson Heart Study found that more diverse social networks are independently associated with lower prevalence of aTRH.24-Abstract, Results, Discussion The burden of hypertension does not fall evenly across all populations. Black adults in the U.S. have the highest prevalence of hypertension. 59% 47% White adults 45% Asian adults 44% Hispanic adults Black people are two to three times more likely to die of preventable CVD and strokes than white people.18-Abstract 17-Racial/Ethnic Disparities in Epidemiology of HTN, U.S. National Data
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