OBJECTIVES:

Sex and race/ethnicity disparities in hypertension (HTN) treatment intensity have been previously described, but it is unclear whether such disparities occur at treatment onset, and the extent to which they may be explained by differences in clinical factors that may guide treatment intensity.

METHODS:

We conducted a retrospective cross-sectional study of adults with newly-treated HTN in the OneFL+ Consortium who had linked claims+EHR data from their treatment initiation visit. We included Florida Medicaid & Medicare recipients diagnosed with HTN and prescribed ≥1 first-line anti-HTN drug during 2013-2020, and without any anti-HTN fills during the year prior. We used generalized linear models to estimate differences in total therapeutic intensity score (TTIS) – a patient’s total daily dose (TDD) divided by the recommended max TDD for a drug, summed across the entire regimen – by sex, race, and ethnicity. We then modeled the same, controlling for demographics, blood pressure (SBP & DBP), BMI, and relevant comorbidities with multiple imputation of missing values for SBP, DBP and BMI.

RESULTS:

A total of 4094 patients (mean age 58.6±18.5; female 57.6%; White 56.7%) were included. In unadjusted analyses, men averaged a 7.6% (95% CI: 3.86%– 11.3%) greater TTIS versus women and Black individuals averaged 10.5% (95%CI: 6.63%–14.4%) greater TTIS versus White individuals, whereas no disparities were observed by ethnicity. After adjusting for clinical factors, these disparities persisted or increased: men had 7.9% (95% CI: 4.14%–11.6%) greater TTIS versus women and Black individuals had 17.1% (95% CI: 13.1%–21.2%) greater TTIS versus White individuals.

CONCLUSIONS:

We observed disparities in treatment intensity by sex and race that were not explained by differences in other clinical factors. Additional research is needed to explain the discordance observed between prior literature indicating worse BP control and outcomes among Black individuals despite the apparent greater treatment intensity at therapy onset.