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(Stroke. 2006;37:1171.)
© 2006 American Heart Association, Inc.

Original Contributions

Racial and Geographic Differences in Awareness, Treatment, and Control of Hypertension

The REasons for Geographic And Racial Differences in Stroke Study

George Howard, DrPh; Ron Prineas, MD, PhD; Claudia Moy, PhD; Mary Cushman, MD, MS; Martha Kellum, MS; Ella Temple, PhD; Andra Graham, BS Virginia Howard, MSPH

From the Departments of Biostatistics (G.H., M.K., E.T.) and Epidemiology (V.H.), School of Public Health, University of Alabama at Birmingham; Department of Public Health Sciences (R.P.), Wake Forest University School of Medicine, Winston Salem, NC; National Institute of Neurological Disorders and Stroke (C.M.), National Institutes of Health, Bethesda, Md; Department of Medicine (M.C.), University of Vermont College of Medicine, Burlington; and Examination Management Services, Incorporated (A.G.), Dallas, Tex.

Correspondence to George Howard, DrPH, Professor and Chair, Department of Biostatistics, School of Public Health, Ryals Building, 1665 University Blvd, University of Alabama at Birmingham, Birmingham, AL 35294. E-mail ghoward{at}uab.edu

Background and Purpose— Stroke mortality is higher in the "Stroke Belt" and among blacks in the United States. Because hypertension is the leading risk factor for stroke, hypertension management (raising awareness, increasing treatment, and improving control) may reduce these disparities.

Methods— Hypertension awareness, treatment, and control were measured in the REasons for Geographic And Racial Differences in Stroke study, a national population-based cohort of black and white participants >45 years of age. At the time of this report, 11 701 had been enrolled. Racial differences and geographic differences (between the Stroke Belt and other regions of the United States) were described.

Results— Black participants were more aware than whites of their hypertension (odds ratio [OR], 1.31; 95% CI, 1.07 to 1.59) and more likely to be on treatment if aware of their diagnosis (OR, 1.69; 95% CI, 1.40 to 2.05), but among those treated for hypertension, they were less likely than whites to have their blood pressure controlled (OR, 0.73; 95% CI, 0.64 to 0.83). There was no evidence of a difference between the Stroke Belt and other regions in awareness of hypertension (OR, 0.95; 95% CI, 0.79 to 1.14), but there was a trend for better treatment (OR, 1.15; 95% CI, 0.97 to 1.37) and control (OR, 1.11; 95% CI, 0.98 to 1.30) in the Stroke Belt region.

Conclusions— These findings suggest that interventions to improve blood pressure control among blacks are promising to reduce the racial disparity in stroke mortality. The lack of substantial geographic differences in hypertension awareness and the trend toward better treatment and control in the Stroke Belt suggest that differences in hypertension management may not be a major contributor to the geographic disparity in stroke mortality.

Key Words: geography • hypertension • racial differences

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