UAB Study Yields New Findings About Southerners and Stroke

Contrary to longstanding belief, hypertension appears not to be the main culprit behind Southerners’ significantly increased risk of stroke when compared to the rest of the country.

February 4, 2005

BIRMINGHAM, AL — Contrary to longstanding belief, hypertension appears not to be the main culprit behind Southerners’ significantly increased risk of stroke when compared to the rest of the country.

That is among the early findings presented here today of an ongoing national study examining racial and geographic differences in stroke risk. The results were reported by George Howard, Dr.P.H., professor and chair of the Department of Biostatistics in the School of Public Health at the University of Alabama at Birmingham (UAB) as part of the International Stroke Conference sponsored by the American Stroke Association, a division of the American Heart Association.

Depending on age and state residence, individuals living in the Southeastern United States have a 40 to 60 percent increased risk of stroke death. “Hypertension remains the leading risk factor for stroke across the nation, and hypertension awareness, treatment and management are very important,” said Howard. “However, in our search to reason why the stroke rate is higher in the South, we must look beyond hypertension.”

It’s commonly perceived that Southerners are less likely to be aware they are hypertensive, are less likely to be treated if they are hypertensive and are less likely to effectively manage their hypertension.

“Not true,” said Howard. “We found Southerners are just as likely to be aware they are hypertensive, they are just as likely — if not more so — to be treated if they are hypertensive, and they are slightly more likely to effectively manage their hypertension.”

The study also looked at racial differences in hypertension awareness, treatment and control. “Findings echo results from previous studies by other research teams,” Howard said. “African-Americans are just as likely as whites to be aware they have hypertension and are just as likely, if not more so, to be treated if they have it. The difference is, African-Americans are less likely to have their hypertension under control.”

The reason for this discrepancy is unclear. “African-Americans are being prescribed medication, but perhaps cannot afford it, aren’t taking it, or it’s not working,” Howard said. “Although we don’t know the answer, the message is clear: interventions aimed at reducing the racial gap in hypertension rates need to focus on improving hypertension controls.”

Results are the first findings of the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a five-year, $28 million study funded by the National Institute of Neurological Disorders and Stroke.

REGARDS is enrolling 30,000 participants, age 45 and older, from across the country to determine why Southerners, especially African-Americans living in the South, are at increased risk for stroke. “We owe a great deal to all of these research volunteers,” Howard said. “Without them, the valuable information gleaned from this research and the interventions that will come from it would not possible.”

Co-researchers of the study are Ronald Prineas, Wake Forest University School of Medicine; Mary Cushman, University of Vermont; Claudia Moy, NINDS; LeaVonne Pulley, University of Arkansas for Medical Sciences; Sean Orr and Camilo Gomez, the Alabama Neurological Institute; and Ella Temple, Ronald Cantrell and Virginia Howard, all of UAB.