Racial Disparities in Treatment of Hypertensive Teens

A Michigan study published in the journal Pediatrics reveals that race differences exist in physicians’ prescribing of drugs to adolescents with hypertension. White adolescents are more likely to receive anti-hypertensive medication compared with black subjects. Under-treatment or delay in the treatment of hypertension in black subjects, as reflected by the findings, warrant attention.

It was also found that adult primary care physicians (PCPs) appear to be the ones mostly prescribing antihypertensive medications to adolescents rather than pediatricians. Two-thirds of those teens received their prescriptions from adult PCPs. 

Primary hypertension or essential hypertension, i.e. high blood pressure with no known cause, is rampant in the adolescent age group, especially in America, and is of great concern to physicians since it is associated with the growing obesity epidemic. Despite this known fact, little has been described about medical management of primary hypertension in adolescents. The recent study describes patterns of antihypertensive prescribing for adolescents with the disease.  

Antihypertensive medications are recommended for adolescents with persistent hypertension despite lifestyle modifications. If treatment using a single class of drugs (monotherapy) doesn’t help to achieve the desired goals, then combination therapy is resorted to. Such a need for combination regimen reflects increased disease severity. 

For this study, 4,296 adolescents with primary hypertension were identified during 2003 to 2008. 66 percent of these were boys; 73 percent were aged 11 to 14 years; 48 percent had obesity-related comorbidity; and 53, 41, and 4 percent were blacks, whites, and Hispanics, respectively. More than one-quarter of the antihypertensive adolescents receive combination therapy.

Startling racial differences with respect to treatment were uncovered.

- Race differences exist in physicians’ prescribing of anti-hypertensives. White adolescents were significantly more likely to receive antihypertensive drugs compared with black subjects. Black subjects may hence suffer under-treatment or delay in treatment for primary hypertension.  

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- An increased use of combination therapy in black subjects was also revealed by the study. Black adolescents with primary hypertension have higher risk of heart diseases compared with non-black adolescents. This may be the rationale for the aggressive blood pressure control using multiple classes of drugs in black adolescents.  

- Primary care physicians or the PCPs, who treat mostly adults, include family physicians, general practitioners, internists, and joint internal medicine-pediatrics specialists. According to this study, it appears that PCPs, rather than paediatricians, are the one who do most of the antihypertensive combination therapy prescriptions for adolescents. Maybe clinicians who are used to manage high blood pressure in adults are more likely to be alarmed by hypertension in adolescents. They may also be more familiar to antihypertensive drugs than pediatricians. These are the plausible explanations for the fact that nearly two-third of the antihypertensive prescriptions for adolescents are by primary care physicians.  

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The researchers recommended further studies to be done to explore the choice of antihypertensive medication and to determine the effectiveness of such treatment.  

Reference: Antihypertensive Prescribing Patterns for Adolescents With Primary Hypertension; Esther Yoon et al; PEDIATRICS 2011.

Source-Medindia