The Contribution of hypertension to black-white differences in likelihood of coronary artery disease detected during elective angiography

Matthew A. Triplette, Joseph S. Rossi, Anthony J. Viera, Mauricio G Cohen, Donald E. Pathman

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

BackgroundBlack 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.MethodsUsing 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.ResultsWe 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.ConclusionsAmong patients electively referred for angiography, hypertension, and its effects may contribute to the lower rate of CAD found in blacks compared to whites.

Original languageEnglish
Pages (from-to)181-186
Number of pages6
JournalAmerican Journal of Hypertension
Volume24
Issue number2
DOIs
StatePublished - Feb 1 2011

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Coronary Artery Disease
Angiography
Hypertension
Odds Ratio
Confidence Intervals
Pathologic Constriction
hydroquinone
Coronary Stenosis
Catheterization
Heart Diseases
Arteries
Logistic Models
Demography
Databases

Keywords

  • blood pressure
  • coronary angiography
  • coronary artery disease
  • hypertension
  • race
  • risk factors

ASJC Scopus subject areas

  • Internal Medicine

Cite this

The Contribution of hypertension to black-white differences in likelihood of coronary artery disease detected during elective angiography. / Triplette, Matthew A.; Rossi, Joseph S.; Viera, Anthony J.; Cohen, Mauricio G; Pathman, Donald E.

In: American Journal of Hypertension, Vol. 24, No. 2, 01.02.2011, p. 181-186.

Research output: Contribution to journalArticle

Triplette, Matthew A. ; Rossi, Joseph S. ; Viera, Anthony J. ; Cohen, Mauricio G ; Pathman, Donald E. / The Contribution of hypertension to black-white differences in likelihood of coronary artery disease detected during elective angiography. In: American Journal of Hypertension. 2011 ; Vol. 24, No. 2. pp. 181-186.
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abstract = "BackgroundBlack 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.MethodsUsing 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.ResultsWe 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.ConclusionsAmong patients electively referred for angiography, hypertension, and its effects may contribute to the lower rate of CAD found in blacks compared to whites.",
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