OBJECTIVES: Studies showed angiotensin II stimulatory antihypertensive (thiazide diuretics, dihydropyridine calcium channel blockers, and angiotensin receptor blockers) was associated with a lower risk of dementia and cognitive impairment compared to angiotensin II–inhibitory antihypertensive (beta-blockers, non-dihydropyridine calcium channel blockers, and angiotensin-converting enzyme). This study aimed to identify the racial and ethnic differences in the use of these agents among US adults with hypertension.

METHODS: A cross-sectional study was conducted using data from the Medical Expenditure Panel Survey (MEPS, 2016-2019). We applied two multivariable logistic regressions comparing racial/ethnic differences in the use of stimulatory vs (inhibitory and others) antihypertensive and inhibitory vs (stimulatory and others) antihypertensive, adjusting for age, sex, race, tobacco use, income level, educational level, health insurance type, region of residency, and comorbidities.

RESULTS: A total of 24,581 individuals aged ≥ 45 years with hypertension and without dementia or Alzheimer's disease were identified. The mean age was similar among stimulatory and inhibitory antihypertensive users (66.5 years). The use of either of these agents was higher among older individuals aged ≥65 years compared to younger adults aged 45-64 years. There were slightly more females (54%) than males taking stimulatory antihypertensive agents. More than two-thirds of the study cohort who received either stimulatory or inhibitory antihypertensive agents were non-Hispanic White. The majority were from high or middle-income classes. Being female (OR 1.261, 95% CI 1.197-1.328), non-Hispanic Black (OR 1.980, 95% CI 1.839-2.132), non-Hispanic Asian (OR 1.545, 95% CI 1.356-1.761), had dyslipidemia (OR 1.100, 95% CI 1.039-1.165), or chronic kidney disease (OR 1.532, 95% CI 1.147-2.047) was associated with using stimulatory agents.

CONCLUSIONS: The results showed that angiotensin II–inhibitory agents were more prevalent than stimulatory agents. Despite the white race being most of this study cohort, the finding showed that non-Hispanic Black and non-Hispanic Asian were prescribed more stimulatory than inhibitory antihypertensive agents.