AAN 2023 | Recognizing and addressing racial disparities in stroke care

Bruce I. Ovbiagele, MD, MSc, FAAN, University of California, San Francisco, CA, discusses racial disparities in stroke care and how to modify practice to promote neurologic health equity. The existence of racial and ethnic disparities in stroke in the United States is long known, and projections show that those disparities are expected to worsen over time. Although the incidence and mortality from stroke have decreased over the last two decades, the disparities, particularly between white and African Americans, haven’t improved. Future strategies to narrow or eliminate these disparities should focus on disparate populations. For instance, it is suspected that there are differential effects of hypertension, the major modifiable risk factor for stroke, with African Americans having a more harmful effect from certain blood pressure levels. Therefore, race-based blood pressure targets should be included in clinical practice guidelines. In treatment-resistant hypertension patients, physiological profiling should be used to target individuals who might be less likely to respond to typical anti-hypertensive treatment protocols. Physiological profiling could be useful to identify patients with low-renin phenotype, particularly common among African Americans, who have greater difficulty in controlling blood pressure. Other factors, such as epigenetics, psychological stress, and social determinants of cerebrovascular health, should also be considered. Importantly, better community partnerships should be developed and sustained to promote neurologic health equity. This interview took place at the American Academy of Neurology Annual Meeting 2023 in Boston, MA.

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