Treatment of hypertension in African Americans and Latinos: the effect of JNC VI on urban prescribing practices

In 1997, national recommendations for the treatment of hypertension were made in the form of the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI). African American hypertensives are considered a special population with a higher prevalence of hypertension, and therefore, unique treatment needs. The study objective was to review medication use among an African American and Latino urban population in relation to the JNC recommendations. The study population was drawn from a preexisting cohort of African Americans and Latinos. Records were reviewed for self-description of hypertension and the use of any antihypertensive medication in individuals less than 60 years of age. A small subgroup of individuals was separately reviewed for specific medications used to treat hypertension. There were 34,118 individuals in the cohort greater than 45 years of age and less than 60 years of age that qualified for review; 40% were African American and 60% were Latino. Of the 13,593 African Americans, 6387 (47%) were hypertensive. Of the 20,525 Latinos, 29% were hypertensive. Only 56% of all hypertensives were on some blood pressure medication (61% of the African Americans and 48% of the Latinos). Within the subgroup of 550 individuals with detailed medication information (223 African Americans and 327 Latinos), calcium channel blockers and diuretics were the most frequently used medication among the African Americans and angiotensin-converting enzyme inhibitors were the most frequently used medication among the Latinos. Beta blockers were used only 13% of the time. The authors concluded that in this cohort of hypertensive urban Latinos and African Americans, more than 40% of individuals were not being treated for hypertension and, despite the guidelines suggested in JNC VI, few individuals were being treated for their hypertension with diuretic monotherapy or beta blockers as first-choice drugs. Instead there was extensive use of calcium channel blockers and angiotensin-converting enzyme inhibitors.