Document Detail

The contribution of hypertension to black-white differences in likelihood of coronary artery disease detected during elective angiography.
MedLine Citation:
PMID:  21088671     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Black patients in the United States undergoing angiography for suspected coronary artery disease (CAD) have consistently been found to have less disease than whites. As the effects of hypertension are greater in blacks than whites, and hypertensive heart disease may mimic CAD and lead to catheterization, we examined the association between race and hypertension as an explanation for the disparities in angiographic CAD.
METHODS: Using an academic hospital's institutional database, we studied patients undergoing first-time elective angiography from 2001 to 2008. Using multivariable logistic regression with data on patient demographics, CAD risk factors, and coronary stenoses, we compared rates of angiographic disease for blacks and whites, creating models separately for patients with and without hypertension. We then tested the significance of an interaction term between race and hypertension on angiographic findings.
RESULTS: We identified 1,203 black and 2,538 white patients who underwent initial elective angiography. Black patients were less likely to have a significant stenotic lesion (≥50% stenosis in the left main artery or ≥70% stenosis elsewhere) than whites (adjusted risk ratio 0.65; 95% confidence interval (CI) 0.55-0.75). Among patients with hypertension this difference was exaggerated (adjusted risk ratio 0.60; 95% CI 0.51-0.71). However, among patients without hypertension, the risk of having a significant lesion was similar in blacks and whites (adjusted risk ratio 0.97; 95% CI 0.67-1.37). The interaction term for race and hypertension was confirmed as statistically significant.
CONCLUSIONS: Among patients electively referred for angiography, hypertension, and its effects may contribute to the lower rate of CAD found in blacks compared to whites.
Matthew A Triplette; Joseph S Rossi; Anthony J Viera; Mauricio G Cohen; Donald E Pathman
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-11-18
Journal Detail:
Title:  American journal of hypertension     Volume:  24     ISSN:  1941-7225     ISO Abbreviation:  Am. J. Hypertens.     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-01-20     Completed Date:  2011-05-03     Revised Date:  2011-06-30    
Medline Journal Info:
Nlm Unique ID:  8803676     Medline TA:  Am J Hypertens     Country:  United States    
Other Details:
Languages:  eng     Pagination:  181-6     Citation Subset:  IM    
Department of Public Health Leadership, University of North Carolina at Chapel Hill, USA.
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MeSH Terms
Academic Medical Centers / statistics & numerical data
African Americans / statistics & numerical data*
Blood Pressure*
Coronary Angiography / statistics & numerical data*
Coronary Stenosis / ethnology*,  physiopathology,  radiography*
European Continental Ancestry Group / statistics & numerical data*
Health Status Disparities*
Hypertension / ethnology*,  physiopathology
Logistic Models
Middle Aged
Predictive Value of Tests
Risk Assessment
Risk Factors
Severity of Illness Index
United States / epidemiology
Comment In:
Am J Hypertens. 2011 Feb;24(2):121   [PMID:  21248729 ]

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