Poorer patients may be less likely than their most well-off counterparts to get their blood pressure under control – even when all have the same access to medication and doctor’s visits free of charge. Shahu et al address this issue by examining the associations of household income with blood pressure control and outcomes including CVD events and all‐cause mortality in a post hoc analysis of ALLHAT (Antihypertensive and Lipid‐Lowering Treatment to Prevent Heart Attack Trial).
To take a closer look at the impact of socioeconomic status on blood pressure control, Shahu and his colleagues reanalyzed data from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) conducted between 1994 and 2002. In that trial, hypertensive patients were randomly assigned to receive one of three blood pressure lowering drugs for six years. In the study, blood pressure above 140/90 mm Hg was considered hypertension that was not under control. Newer American Heart Association guidelines put that cutoff at 130/80 mm Hg.
The researchers focused on 27,862 ALLHAT participants who received care in a total of 372 counties. Because the trial didn’t collect information on individuals’ income, Shahu and his colleagues used the income level of the county where study participants got their care as a proxy. That meant 2,169 patients fell into the lowest of five income brackets and 10,458 got care in the highest-income counties.
Participants in the lowest-income group were more likely to be women, to be black or Hispanic, to have fewer years of education, to live in the South and to have fewer cardiovascular risk factors.
When the researchers compared the patients from the poorest counties to those from the wealthiest, they found that, after accounting for cardiovascular risk factors, the poorest patients were 52% less likely to reach the blood pressure goal of 140/90 mm Hg, were 25% more likely to die from any cause, were 26% more likely to be hospitalized or die from heart failure and 86% more likely to develop end-stage kidney disease.
One big issue that was not accounted for in the original study is whether patients were taking their blood pressure medications as prescribed. The new findings may be a sign that patients aren’t getting properly educated about the importance of their medications.
Read the article here.
Sources: Reuters Health & Journal of the American Heart Association