High BP not causing Stroke Belt
High BP not causing Stroke Belt
February 9, 2005
New Orleans, LA - First data from a new US-wide epidemiological study of stroke have turned up a surprising finding, the fact that the higher rate of stroke death known to occur in the Southern states--known as the "Stroke Belt"--may not be just due to hypertension.
Statistician Dr George Howard (University of Alabama at Birmingham) reported the first results from the Racial and Regional Differences in Awareness, Treatment, and Control of Blood Pressure (REGARDS) study during a late-breaking session at the American Stroke Association International Stroke Conference last week.
The study shows that, contrary to popular belief, those in the South are as aware of hypertension and as likely to be receiving treatment as people elsewhere in the US. Also, they were more likely to have their hypertension controlled than those living in non-Southern states.
Differences in awareness, treatment, and control of hypertension between Southerners and non-Southerners
All of this indicates that "hypertension is probably not what's causing this," Howard told heartwire . "If we think we can eliminate the Stroke Belt through hypertension control, that's not going to happen." He says there are many other theories about what may be contributing to the excess stroke mortality seen in the Southern states--which is about 40% to 60% higher than the rest of the country--and that it is hoped that the REGARDS study will help to determine which factors are playing a part.
Other factors at play
So far, Howard and colleagues have recruited about half of the REGARDS participants--the aim is to have 30 000 in total, half of whom will be African American, half white. Half will be from the Southern states, and half will be from non-Southern states. All participants will be over 45, and half will be women. The study will run for five years and is being funded by the National Institutes for Neurological Disorders and Stroke (NINDS).
The analysis presented last week is based on the first 11 606 participants and, as mentioned, shows no difference so far between those living in the South and those not, except that those in the Stroke Belt are more likely to have their hypertension controlled. However, adjustment for demographic, socioeconomic, and risk-factor confounders largely mediated the regional difference in control, but had little impact on the other comparisons.
"The lack of regional differences in awareness, treatment, and control of hypertension implies that factors other than hypertension may be contributing to the excess stroke mortality in the Stroke Belt," Howard says.
Other possible factors include socioeconomic status, diet, quality of healthcare facilities, smoking, and infections. "We will look at these hypotheses and others over the course of the REGARDS study," he noted.
African Americans less likely to have hypertension under control
The study also looked at racial differences and showed that blacks are more aware of their hypertension than whites and more likely to be getting treatment for problem. They are, however, less likely to have their hypertension under control than whites.
Differences in awareness, treatment and control of hypertension between blacks and whites
To download tables as slides, click on slide logo below
"There are a number of possible reasons for this," says Howard. "First, we know that African Americans are going to the doctors and getting treatment, but there is no adequate follow-up; they are not returning." There could also be socioeconomic factors at play, he noted, so that blacks are getting prescriptions but cannot afford to fill them. Differences in the efficacy of drugs between the races may play a part, as may physician bias in terms of how aggressively they treat different groups of patients, he notes.
"Although we don't know the answer, the message is clear: interventions aimed at reducing the racial gap in hypertension rates need to focus on improving hypertension control," he concludes.
Source
February 9, 2005
New Orleans, LA - First data from a new US-wide epidemiological study of stroke have turned up a surprising finding, the fact that the higher rate of stroke death known to occur in the Southern states--known as the "Stroke Belt"--may not be just due to hypertension.
Statistician Dr George Howard (University of Alabama at Birmingham) reported the first results from the Racial and Regional Differences in Awareness, Treatment, and Control of Blood Pressure (REGARDS) study during a late-breaking session at the American Stroke Association International Stroke Conference last week.
The study shows that, contrary to popular belief, those in the South are as aware of hypertension and as likely to be receiving treatment as people elsewhere in the US. Also, they were more likely to have their hypertension controlled than those living in non-Southern states.
Differences in awareness, treatment, and control of hypertension between Southerners and non-Southerners
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All of this indicates that "hypertension is probably not what's causing this," Howard told heartwire . "If we think we can eliminate the Stroke Belt through hypertension control, that's not going to happen." He says there are many other theories about what may be contributing to the excess stroke mortality seen in the Southern states--which is about 40% to 60% higher than the rest of the country--and that it is hoped that the REGARDS study will help to determine which factors are playing a part.
Other factors at play
So far, Howard and colleagues have recruited about half of the REGARDS participants--the aim is to have 30 000 in total, half of whom will be African American, half white. Half will be from the Southern states, and half will be from non-Southern states. All participants will be over 45, and half will be women. The study will run for five years and is being funded by the National Institutes for Neurological Disorders and Stroke (NINDS).
The analysis presented last week is based on the first 11 606 participants and, as mentioned, shows no difference so far between those living in the South and those not, except that those in the Stroke Belt are more likely to have their hypertension controlled. However, adjustment for demographic, socioeconomic, and risk-factor confounders largely mediated the regional difference in control, but had little impact on the other comparisons.
"The lack of regional differences in awareness, treatment, and control of hypertension implies that factors other than hypertension may be contributing to the excess stroke mortality in the Stroke Belt," Howard says.
Other possible factors include socioeconomic status, diet, quality of healthcare facilities, smoking, and infections. "We will look at these hypotheses and others over the course of the REGARDS study," he noted.
African Americans less likely to have hypertension under control
The study also looked at racial differences and showed that blacks are more aware of their hypertension than whites and more likely to be getting treatment for problem. They are, however, less likely to have their hypertension under control than whites.
Differences in awareness, treatment and control of hypertension between blacks and whites
|
To download tables as slides, click on slide logo below
"There are a number of possible reasons for this," says Howard. "First, we know that African Americans are going to the doctors and getting treatment, but there is no adequate follow-up; they are not returning." There could also be socioeconomic factors at play, he noted, so that blacks are getting prescriptions but cannot afford to fill them. Differences in the efficacy of drugs between the races may play a part, as may physician bias in terms of how aggressively they treat different groups of patients, he notes.
"Although we don't know the answer, the message is clear: interventions aimed at reducing the racial gap in hypertension rates need to focus on improving hypertension control," he concludes.
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