Hypertension (HTN) is associated with a worsened disease course in multiple sclerosis (MS) patients. BAs are more likely to develop HTN than WAs.

To determine the odds of uncontrolled HTN in Black Americans (BAs) vs. White Americans (WAs) with MS and whether there are racial disparities in anti-hypertensive treatment.

Multiple Sclerosis Partners Advancing Technology Health Solutions (MS PATHS) collects multi-institutional longitudinal data on MS patients. MS PATHS data were analyzed and patients with ≥2 blood pressure (BP) readings ≥140/90 were identified as having uncontrolled HTN. Logistic regression determined the odds of uncontrolled HTN in BAs versus WAs while adjusting for important covariates including age, disease duration, MS phenotype, insurance type, diabetes (DM), and hyperlipidemia (HLD). The adjusted odds of being on anti-hypertensive medications in BAs versus WAs with uncontrolled HTN and MS were determined. Factors associated with receiving anti-hypertensive treatment were analyzed.

There were 10,673 patients with ≥2 BP measurements of whom 3,112 (28%) had uncontrolled HTN. The WA cohort was older (mean age 49.2 vs. 45.7 for BAs), but uncontrolled HTN was more prevalent in BAs (32.6%) as compared to WAs (28.3%). BAs had 31% increased odds of uncontrolled HTN than WAs (p<0.001). BAs with uncontrolled HTN had 68% (p<0.001) higher odds of being on an anti-hypertensive compared to WAs. Older age (OR=1.06, p<0.001), comorbid HLD (OR=3.93, p<0.001), and comorbid DM (OR=7.09, p<0.001) were associated with higher odds of BAs with uncontrolled HTN being on anti-hypertensive therapy. Similar relationships were seen among WA MS patients, but the effects of DM (OR=4.15, p<0.001) and HLD (OR=2.29, p<0.001) were less pronounced.

In this large MS cohort, BAs had significantly higher odds of uncontrolled HTN but were more likely to be on anti-hypertensive medications. This paradoxical finding requires further investigation. Future longitudinal studies will explore potential explanations.