Hypertension disease natural history and healthcare utilization when treatment guidelines do not account for race
- 1Johns Hopkins Bloomberg School of Public Health
Abstract
ObjectiveTo estimate the impact of removing race-adjusted antihypertensive treatment recommendations for Black adults on health outcomes, healthcare utilization, and racial/ethnic disparities.
Materials and methodsA discrete-time state-transition microsimulation model of hypertension natural history and health system utilization was developed to simulate lifetime trajectories among 100,000 non-Hispanic Black and non-Hispanic white 40-year-old adults. We evaluated the effect of removing race-adjusted antihypertensive treatment recommendations under two scenarios: one assuming racial heterogeneity in treatment effectiveness, reflecting evidence behind prior race-specific guidelines, and the other assuming no racial heterogeneity. Our main outcomes included life expectancy, cumulative incidence and duration of hypertension, and blood pressure control with antihypertensive treatment.
ResultsUnder assumptions of heterogeneous treatment effectiveness by race, guidelines without race adjustment decreased life expectancy among non-Hispanic Black adults by 0.4 years, increasing the life expectancy gap with non-Hispanic white adults from 4.1 to 4.5 years. Hypertension control among non-Hispanic Black adults also worsened. Years with uncontrolled hypertension increased by 0.8 years, widening the disparity with non-Hispanic white adults from 1.7 to 2.5 years. Assuming no racial heterogeneity, these effects were diminished: life expectancy decreased by 0.1 years and years with uncontrolled hypertension increased by 0.2 years, less than one-half and one-quarter of the effects observed under assumptions of heterogeneous treatment effectiveness by race.
DiscussionThe potential effects of removing race-adjusted antihypertensive treatment guidelines depended on assumptions of racial heterogeneity in treatment effectiveness.
ConclusionOur findings highlight the importance of understanding drivers of previously observed racial differences when considering modifying antihypertensive treatment guidelines.
Related
- Sickle Cell Disease Care in Jamaica: Enablers and Barriers to Healthcare Access and Hydroxyurea Utilization
- GLP-1 Receptor Agonists and Risk of Kidney Replacement Therapy and Healthcare Utilization in Bipolar Disorder with Chronic Kidney Disease
- Associations of Cancer Rehabilitation During Hospitalization for Cancer Treatment With Survival and Post–Discharge Healthcare Utilization: A Multicenter Retrospective Cohort Study
- Nutritional status, clinical burden, and healthcare utilization among pediatric outpatients with congenital heart disease: A retrospective cross-sectional study from Indonesia
- Impact of diabetic kidney disease on in-hospital complications and healthcare utilization following primary shoulder arthroplasty: a national database analysis.
BibTeX
@misc{cusick2026hypertension,
title = {{Hypertension disease natural history and healthcare utilization when treatment guidelines do not account for race}},
author = {M. M. Cusick and M. Barrett and F. Alarid-Escudero and J. D. Goldhaber-Fiebert and S. Rose},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.05.26364804},
url = {https://www.medrxiv.org/content/10.64898/2026.10.05.26364804v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Hypertension disease natural history and healthcare utilization when treatment guidelines do not account for race
AU - M. M. Cusick
AU - M. Barrett
AU - F. Alarid-Escudero
AU - J. D. Goldhaber-Fiebert
AU - S. Rose
PY - 2026
DA - 2026/10/05
PB - medRxiv
DO - 10.64898/2026.10.05.26364804
UR - https://www.medrxiv.org/content/10.64898/2026.10.05.26364804v1
AB - ObjectiveTo estimate the impact of removing race-adjusted antihypertensive treatment recommendations for Black adults on health outcomes, healthcare utilization, and racial/ethnic disparities. Materials and methodsA discrete-time state-transition microsimulation model of hypertension natural history and health system utilization was developed to simulate lifetime trajectories among 100,000 non-Hispanic Black and non-Hispanic white 40-year-old adults. We evaluated the effect of removing race-adjusted antihypertensive treatment recommendations under two scenarios: one assuming racial heterogeneity in treatment effectiveness, reflecting evidence behind prior race-specific guidelines, and the other assuming no racial heterogeneity. Our main outcomes included life expectancy, cumulative incidence and duration of hypertension, and blood pressure control with antihypertensive treatment. ResultsUnder assumptions of heterogeneous treatment effectiveness by race, guidelines without race adjustment decreased life expectancy among non-Hispanic Black adults by 0.4 years, increasing the life expectancy gap with non-Hispanic white adults from 4.1 to 4.5 years. Hypertension control among non-Hispanic Black adults also worsened. Years with uncontrolled hypertension increased by 0.8 years, widening the disparity with non-Hispanic white adults from 1.7 to 2.5 years. Assuming no racial heterogeneity, these effects were diminished: life expectancy decreased by 0.1 years and years with uncontrolled hypertension increased by 0.2 years, less than one-half and one-quarter of the effects observed under assumptions of heterogeneous treatment effectiveness by race. DiscussionThe potential effects of removing race-adjusted antihypertensive treatment guidelines depended on assumptions of racial heterogeneity in treatment effectiveness. ConclusionOur findings highlight the importance of understanding drivers of previously observed racial differences when considering modifying antihypertensive treatment guidelines.
ER -