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Management of chest pain in patients with hypertension differs in men, women, and ethnic groups

About one of eight patients with hypertension treated by primary care doctors are diagnosed with some type of chest pain syndrome (CPS), and these patients are usually aggressively treated for cardiovascular risk factors. However, management of these patients differs by ethnicity and sex, according to a study supported in part by the Agency for Healthcare Research and Quality (HS10871).

The chest pain syndromes studied included general chest pain, angina (chest pain, tightness, or pressure due to lack of oxygen to the heart muscle), chronic angina, and pre-heart attack angina/intermediate coronary syndrome (ICS). More men than women were diagnosed with angina (18 vs. 4 percent) and ICS (21 vs. 10 percent), while more women than men were diagnosed with vague chest pain only (86 vs. 61 percent). Blacks also received more chest pain diagnoses than whites (71 vs. 62 percent), similar angina diagnoses (14 vs. 16 percent), and slightly fewer ICS diagnoses (15 vs. 22 percent). However, women and blacks with CPS received fewer cardiovascular medications than men and whites, respectively, both overall and within diagnostic categories.

Researchers analyzed the care of 72,508 people with hypertension listed in the Hypertension Initiative primary care database who were receiving care at about 50 primary care practices in the Southeastern United States. Overall, 11 percent of patients with hypertension had CPS, and most of these patients were prescribed statin drugs, aspirin, angiotensin converting enzyme inhibitors, and diuretics. About half were prescribed a beta-blocker.

More details are in "Prevalence, treatment, and control of chest pain syndromes and associated risk factors in hypertensive patients," by Katharine H. Hendrix, M.S., Ph.D., Susan Mayhan, Daniel T. Lackland, Dr.P.H., and Brent M. Egan, M.D., in the August 2005 American Journal of Hypertension 18(8), pp. 1026-1032.

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