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Background: Few studies have examined racial/ethnic differences in blood pressure (BP) control over time, especially in an equal access system. We examined racial/ethnic differences in longitudinal BP control in Veterans with type 2 diabetes., Methods: We collected data on a retrospective cohort of 5,319 Veterans with type 2 diabetes and initially uncontrolled BP followed from 1996 to 2006 at a Veterans Administration (VA) facility in the southeastern United States. The mean blood pressure value for each subject for each year was used for the analysis with BP control defined as <140/<90 mmHg. The primary outcome measure was proportion with controlled BP. The main predictor variable was race/ethnicity categorized as non-Hispanic White (NHW), non-Hispanic Black (NHB), or Hispanic/Other (H/O). Other covariates included age, gender, employment, marital status, service connectedness, and ICD-9 coded medical and psychiatric comorbidities. Generalized linear mixed models were used to assess the relationship between race/ethnicity and BP control after adjusting for covariates., Results: Mean follow-up was 5.0 years. The sample was 46% NHW, 26% NHB, 19% H/O, and 9% unknown. The average age was 68 years. In the final model, after adjusting for covariates, NHB race (OR = 1.38, 95%CI: 1.2, 1.6) and H/O race (OR = 1.57, 95% CI: 1.3, 1.8) were associated with increased likelihood of poor BP control (>140/>90 mmHg) over time compared to NHW patients., Conclusion: Ethnic minority Veterans with type 2 diabetes have significantly increased odds of poor BP control over ∼5 years of follow-up compared to their non-Hispanic White counterparts independent of sociodemographic factors and comorbidity patterns.

Background: Few studies have examined racial/ethnic differences in blood pressure (BP) control over time, especially in an equal access system. We examined racial/ethnic differences in longitudinal BP control in Veterans with type 2 diabetes.Methods: We collected data on a retrospective cohort of 5,319 Veterans with type 2 diabetes and initially uncontrolled BP followed from 1996 to 2006 at a Veterans Administration (VA) facility in the southeastern United States. The mean blood pressure value for each subject for each year was used for the analysis with BP control defined as <140/<90 mmHg. The primary outcome measure was proportion with controlled BP. The main predictor variable was race/ethnicity categorized as non-Hispanic White (NHW), non-Hispanic Black (NHB), or Hispanic/Other (H/O). Other covariates included age, gender, employment, marital status, service connectedness, and ICD-9 coded medical and psychiatric comorbidities. Generalized linear mixed models were used to assess the relationship between race/ethnicity and BP control after adjusting for covariates.Results: Mean follow-up was 5.0 years. The sample was 46% NHW, 26% NHB, 19% H/O, and 9% unknown. The average age was 68 years. In the final model, after adjusting for covariates, NHB race (OR = 1.38, 95%CI: 1.2, 1.6) and H/O race (OR = 1.57, 95% CI: 1.3, 1.8) were associated with increased likelihood of poor BP control (>140/>90 mmHg) over time compared to NHW patients.Conclusion: Ethnic minority Veterans with type 2 diabetes have significantly increased odds of poor BP control over ∼5 years of follow-up compared to their non-Hispanic White counterparts independent of sociodemographic factors and comorbidity patterns. [ABSTRACT FROM AUTHOR]

BackgroundHypertension (HTN) is a prevalent and important risk factor for both cardiovascular and all-cause mortality. Depression is often present in hypertensive patients and has also been associated with increased mortality risk. The aim of this study was to evaluate the association of depressive symptoms with all-cause mortality and ischemic heart disease (IHD) mortality among adults with self-reported HTN.MethodsWe studied 10,025 participants in the National Health and Nutrition Epidemiologic Follow-up Study (NHANES I) who were alive and interviewed in 1982 and had complete data for the Center for Epidemiologic Studies Depression Scale (CES-D). Four groups were identified based screening status at initial interview: (i) no HTN, no depression (reference group); (ii) HTN, no depression; (iii) no HTN, depression; and (iv) both HTN and depression. Cox proportional hazards regression was used to calculate multivariate-adjusted hazard ratios (HRs) of death for each group.ResultsOver an average of 8 years (83,943 person-years) of follow-up, patients with both self-reported HTN and depressive symptoms had the highest multivariate-adjusted HR for all-cause mortality at 1.39 (95% confidence interval (CI) 1.14, 1.69) as well as for IHD mortality at 1.59 (95% CI 1.08, 2.34). In post hoc analysis, nondepressed hypertensive patients had significantly lower adjusted HR for all-cause mortality compared to depressed hypertensive patients (HR 0.85; 95% CI 0.73–1.00), but the HR for IHD mortality was not significant (HR 0.87, 95% CI 0.63–1.20).ConclusionComorbid depressive symptoms are associated with increased all-cause mortality in patients with self-reported HTN.American Journal of Hypertension 2010; doi:10.1038/ajh.2009.199 [ABSTRACT FROM AUTHOR]

An introduction to the journal is presented in which the editors discuss the article regarding the importance of vitamin D deficiency in mediating racial differences in blood pressure by K. Fiscella and colleagues.

Background-Despite progress, many hypertensive patients remain uncontrolled. Defining characteristics of uncontrolled hypertensives may facilitate efforts to improve blood pressure control. Methods and Results-Subjects included 13 375 hypertensive adults from National Health and Nutrition Examination Surveys (NHANESs) subdivided into 1988 to 1994, 1999 to 2004, and 2005 to 2008. Uncontrolled hypertension was defined as blood pressure ⩾140/⩾90 mm Hg and apparent treatment-resistant hypertension (aTRH) when subjects reported taking ⩾3 antihypertensive medications. Framingham 10-year coronary risk was calculated. Multivariable logistic regression was used to identify clinical characteristics associated with untreated, treated uncontrolled on 1 to 2 blood pressure medications, and aTRH across all 3 survey periods. More than half of uncontrolled hypertensives were untreated across surveys, including 52.2% in 2005 to 2008. Clinical factors linked with untreated hypertension included male sex, infrequent healthcare visits (0 to 1 per year), body mass index <25 kg/m2, absence of chronic kidney disease, and Framingham 10-year coronary risk <10% (P<0.01). Most treated uncontrolled patients reported taking 1 to 2 blood pressure medications, a proxy for therapeutic inertia. This group was older, had higher Framingham 10-year coronary risk than patients controlled on 1 to 2 medications (P<0.01), and comprised 34.4% of all uncontrolled and 72.0% of treated uncontrolled patients in 2005 to 2008. We found that aTRH increased from 15.9% (1998-2004) to 28.0% (2005-2008) of treated patients (P<0.001). Clinical characteristics associated with aTRH included ⩾4 visits per year, obesity, chronic kidney disease, and Framingham 10-year coronary risk >20% (P<0.01). Conclusion-Untreated, undertreated, and aTRH patients have consistent characteristics that could inform strategies to improve blood pressure control by decreasing untreated hypertension, reducing therapeutic inertia in undertreated patients, and enhancing therapeutic efficiency in aTRH. [ABSTRACT FROM AUTHOR]