Black Patients With MS at Higher Risk for Uncontrolled Hypertension

Blackpatients with multiple sclerosis have significantly increased odds of uncontrolled hypertension, according to a new study. At the same time, Black Americans have higher odds of receiving anti-hypertensive treatment, according to a new study in Science Direct article.

Hypertension adversely impacts the multiple sclerosis (MS) disease course and is more common among Black Americans. And, while MS used to be predominant among White Americans, recent studies suggest the risk of MS among Blacks is increasing. One retrospective study found a 47% increased risk of MS in Black Americans compared with White Americans, investigators noted.

Additionally, several studies suggest Black Americans experience earlier disability and a more severe disease course, and that social determinants of health and structural racism are likely to play a role in these observations, he added.

Devon Conway, M.D.

In the current study, investigators, led by Devon Conway, M.D., conducted a retrospective study using longitudinal data in the Multiple Sclerosis Partners Advancing Technology and Health Solutions (MS PATHS) registry. Conway is a neurologist at the Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic Foundation.

They found that uncontrolled hypertension was common in MS patients regardless of race, but more common in Black Americans. Out of 10,673 total MS patients (13.5% were Black), Black MS patients had a 31% increased odds of uncontrolled hypertension compared with White patients. After adjustment for relevant covariates, mean systolic blood pressure was 1.84 mmHg higher in Black Americans than White Americans, and mean diastolic blood pressure was 1.28 mmHg higher.

Black Americans were also more likely to be on anti-hypertensive therapy and were exposed to an adjusted average of 0.61 more anti-hypertensive treatments than White Americans. Age, comorbid diabetes mellitus, and comorbid hyperlipidemia were positively associated with use of anti-hypertensive treatments.

In addition, data from the National Health and Nutrition Examination Survey showed that Black Americans with hypertension were more likely to have uncontrolled hypertension than White Americans (57% versus 51%). However, among those with uncontrolled hypertension, Blacks had greater awareness and treatment compared with White Americans.

Black Americans were more likely to have treatment-resistant hypertension compared with White Americans (16.7% versus 11.3%), and among those with treatment resistant hypertension, Blacks were more likely to have refractory hypertension (an extreme phenotype of anti-hypertensive treatment failure) than Whites (4.8% versus 1.2%).