Abstract P123: Antihypertensive Medication Use and Hypertension Control Among Hispanic/Latino Adults With Hypertension: Findings From Hispanic Community Health Study/Study of Latinos
Authors: Guadamuz Jenny S , Lee David , Daviglus Martha L , Durazo-Arvizu Ramon A , Wassertheil-Smoller Sylvia , Kizer Jorge R , Qato Dima M 
Published: March 2019

Background:
Despite disparities in hypertension prevalence, treatment, and control by Hispanic/Latino background, there is limited information on the role of antihypertensive use in hypertension control. This study estimated antihypertensive use and hypertension control and examined the association between antihypertensive use and hypertension control among Latinos with hypertension.

Methods:
Data from the Hispanic Community Health Study/Study of Latinos, a population-based cohort study, was used to estimate antihypertensive use and hypertension control among Latinos by background, sociodemographic, clinical, and healthcare factors. Hypertension was defined as systolic BP ≥140, diastolic BP ≥90 mm Hg, or self-reported antihypertensive use. Hypertension control was defined as systolic BP<140 and diastolic BP<90 mm Hg. Antihypertensive use was defined as the use of a diuretic, ACE inhibitor, ARB, β-blocker, CCB, or another antihypertensive in the month prior to study examination. Logistic regressions that examine antihypertensive use and hypertension control were multivariate adjusted. Analyses were limited to Latinos with hypertension in 2014-17 (n=5,354).

Results:
Antihypertensive use was 58.7% overall and was higher among Cubans (67.4%) when compared to individuals of other backgrounds (Mexican 53.4%, Puerto Rican 59.8%, Dominican 56.3%, Central American 52.0%, South American 49.8%, P<0.001). Commonly used antihypertensive classes include ACE inhibitors (28.3%), diuretics (16.7%), β-blockers (18.0%), ARBs (15.7%), and CCBs (13.0%). Use of antihypertensive classes varied by background—e.g., a greater share of Cubans used β-blockers (26.0%) and ARBs (19.2%) and a greater share of Puerto Ricans used CCBs (17.6%). Less than half of Latinos achieved hypertension control (48.6%); with the highest share of control among Mexicans (54.0%; P<0.001). Among Latinos with treated hypertension, 61.5% achieved control. In adjusted analyses, we found that Cubans had higher odds of antihypertensive use compared to Mexicans (OR 1.63 [CI 1.18-2.26], P<0.01). However, Cubans, Dominicans, and Central Americans had reduced odds of control, even after adjusting for antihypertensive use (OR 0.57 [CI 0.43-0.77]; 0.55 [CI 0.39-0.80]; 0.53 [CI 0.39-0.73]; all P<0.01). Antihypertensive use was positively associated with hypertension control in all backgrounds—in stratified analyses, associations were strongest among Central and South Americans and weakest among Puerto Ricans and Dominicans. Multiple antihypertensive use was not associated with control among Latinos with treated hypertension.

Conclusions:
The use of antihypertensives varies in Latino adults with hypertension and is associated with differences in hypertension control. Efforts to increase use of antihypertensives can reduce disparities in hypertension control in the diverse Latino population in the US.