Stronger blood pressure treatment did not significantly change racial or ethnic differences in stroke, according to Gram Research analysis of 10,005 U.S. adults with high blood pressure from 2013 to 2020. Smoking, prior heart disease, and Medicaid coverage were linked to higher stroke odds. The interaction test returned p = 0.346, so the link between medicine use and racial gaps could not be confirmed.
A Gram Research analysis of a 2026 study in the Journal of Racial and Ethnic Health Disparities looked at 10,005 U.S. adults with high blood pressure. The researchers wanted to know whether stroke history differed by race, ethnicity, and blood pressure medication use. About 5% of participants reported having had a stroke. Current smoking, a history of heart disease, and Medicaid coverage were each linked to higher stroke rates. Stroke rates differed between racial and ethnic groups, but the differences did not clearly change with the number or type of medicines people took. The researchers found no clear evidence that stronger treatment closed racial gaps in stroke. They say larger studies that track blood pressure control and medication use over time are needed to answer this question.
Key Statistics
A 2026 study of 10,005 U.S. adults with high blood pressure, drawn from national health surveys conducted between 2013 and 2020, found that about 5% of participants reported having had a stroke.
In that same study, current smoking was linked to 1.80 times the odds of stroke and a history of cardiovascular disease was linked to 2.38 times the odds, after adjusting for other factors.
Among untreated adults with high blood pressure, predicted stroke prevalence was 3.5% for Black participants and 2.8% for White participants, while people on combination therapy showed 7.0% and 6.8%, respectively.
The Quick Take
- What they studied: Researchers asked whether stroke rates among adults with high blood pressure differ by race or ethnicity, and whether those differences change depending on whether people take no medicine, one medicine, or several medicines.
- Who participated: The study included 10,005 U.S. adults aged 20 and older who had high blood pressure. They were part of a national health survey conducted from 2013 to 2020, and they included White, Black, Asian, and Hispanic participants.
- Key finding: About 5% of participants reported a past stroke. Current smoking, a history of heart disease, and Medicaid coverage were each linked to higher stroke odds after accounting for other factors. The study found no clear evidence that medicine intensity changed racial or ethnic differences in stroke (p = 0.346).
- What it means for you: If you have high blood pressure, controlling it and quitting smoking are well-supported steps for lowering stroke risk. This study alone does not show that taking more medicine lowers stroke risk for any racial or ethnic group, so talk with your doctor before changing your treatment.
The Research Details
This study used data from the National Health and Nutrition Examination Survey, a large national health survey run in the United States. The researchers included adults aged 20 and older who had high blood pressure, and they collected data from March 2013 to March 2020. Stroke history was based on what participants told the surveyors, not on medical records.
Participants were grouped by their blood pressure treatment: no medicine, one medicine (monotherapy), or two or more medicines (combination therapy). The team then used statistical models that adjusted for factors such as age, income, insurance, smoking, and existing heart disease. This adjustment helps separate the effect of each factor from the others.
To test whether treatment changed racial or ethnic gaps, the researchers added a special term to their model that combined race and medicine group. This kind of test checks whether the effect of one factor depends on another.
A survey like this can include thousands of people from many backgrounds, which helps researchers compare groups. Because the data were gathered at one point in time, the study can show which factors are linked to stroke, but it cannot prove that any one factor causes stroke. The adjustment step also helps reduce the chance that differences in age or income alone explain the results.
The study used a large national sample and standard statistical methods, which are strengths. However, stroke history was self-reported, so some people may have forgotten or misreported past strokes. The study also did not measure how well blood pressure was controlled over time or whether people took their medicine as prescribed, which could affect the results. Some estimates for specific groups, such as Asian participants and Medicaid enrollees, had wide confidence intervals, meaning the true values could be quite different from the reported numbers.
What the Results Show
Of the 10,005 adults studied, about 5% reported a history of stroke. After adjusting for other factors, three characteristics stood out. Current smoking was linked to 1.80 times the odds of stroke (95% confidence interval 1.27 to 2.56). A history of cardiovascular disease was linked to 2.38 times the odds (95% confidence interval 1.70 to 3.35). Medicaid coverage was linked to 3.06 times the odds (95% confidence interval 1.40 to 6.68).
Stroke rates differed between groups, but the study’s test for whether medicine intensity changed these differences was not statistically significant (p = 0.346). In plain terms, the researchers could not confirm that taking more medicines changed the gap between racial or ethnic groups. Among people who took no blood pressure medicine, predicted stroke rates were 3.5% for Black participants and 2.8% for White participants. Among people on combination therapy, the predicted rates were 7.0% and 6.8%, respectively.
Hispanic participants had lower odds of stroke than White participants across medication categories. The adjusted odds ratio was 0.66 for those not on medicine and 0.57 for those on combination therapy. Asian participants showed lower odds on combination therapy (adjusted odds ratio 0.23), but this estimate had a very wide range, so it should be read cautiously.
The study also highlights how many factors beyond medicine relate to stroke. Smoking and prior heart disease are well-known stroke risks, and this study adds that insurance type was also linked to stroke odds in this population. Insurance may reflect differences in income, access to care, or other social conditions, but the study could not identify the exact reason. The lower odds seen among Hispanic participants were consistent across treatment groups, which the authors highlight as a pattern worth further study.
Earlier research has consistently found that Black adults in the United States have higher rates of stroke and high blood pressure than White adults. This study reflects that pattern in the untreated group, where Black participants had a higher predicted stroke rate. The lack of a clear treatment effect on these gaps suggests that medicine alone may not fully explain why disparities persist, a point that matches the authors’ call for broader research into access, adherence, and blood pressure control.
The study is cross-sectional, which means it captures a snapshot in time. It cannot show whether medicines caused changes in stroke risk or whether stroke changed treatment decisions. Stroke history was self-reported, so memory or reporting errors are possible. The study did not include data on how well blood pressure was controlled, how consistently people took their medicine, or how severe their high blood pressure was. Several subgroup estimates had wide confidence intervals, so small groups may not give reliable answers.
The Bottom Line
Research shows that smoking, a history of heart disease, and Medicaid coverage are each linked to higher stroke odds among adults with high blood pressure, so reducing smoking and managing blood pressure remain well-supported steps. The study does not show that more medicine closes racial or ethnic gaps in stroke, so confidence in any treatment-intensity recommendation from this study alone is low. Decisions about medicine should be made with a doctor who knows your full health history.
Adults with high blood pressure, especially those who smoke, have heart disease, or have Medicaid coverage, may find these results relevant. Clinicians, public health workers, and researchers working on stroke prevention and health equity should also pay attention. People without high blood pressure or those already under a doctor’s care for treatment decisions should not change their medicine based on this study alone.
Blood pressure medicines often begin to lower pressure within a few weeks, but reducing stroke risk takes longer and is hard to measure in a single study. Quitting smoking can start lowering stroke risk within a few years, and continued blood pressure control supports lower risk over many years. Results of any personal change should be checked with a doctor over months and years, not days.
Frequently Asked Questions
Does blood pressure medicine affect stroke risk differently for Black and White adults?
A 2026 study of 10,005 U.S. adults found no statistically significant evidence that treatment intensity changed racial gaps in stroke (p = 0.346). Predicted stroke rates were 3.5% for untreated Black adults and 2.8% for untreated White adults.
What factors are linked to a higher chance of stroke in people with high blood pressure?
Current smoking, a history of cardiovascular disease, and Medicaid coverage were each linked to higher stroke odds in a study of 10,005 U.S. adults. Smoking carried adjusted odds of 1.80 and prior heart disease carried 2.38. These links do not prove cause and effect.
Did the study find that Hispanic adults had different stroke odds than White adults?
Hispanic adults had lower odds of stroke than White adults in the study. Adjusted odds were 0.66 for those not on medicine and 0.57 for those on combination therapy, based on national survey data from 2013 to 2020.
Can taking more blood pressure medicine lower stroke risk?
This study could not establish that. Stroke rates were higher among people on combination therapy (about 7%) than among untreated people (about 3%), which may reflect more severe high blood pressure. The study design cannot show whether medicines prevent strokes.
Want to Apply This Research?
- Log your blood pressure readings at least three times per week, at the same time of day, and note whether you took your medicine that day. Track your average weekly reading over several months to see trends.
- Set a daily reminder for your blood pressure medicine and mark each dose in the app. If you smoke, log cigarettes per day and set a weekly goal to reduce them, and share your progress with your doctor at visits.
- Review your blood pressure trend and medicine adherence each month, and bring a summary to each clinic visit. Over the long term, track smoking status, weight, and any new heart-related diagnoses so you and your care team can see the full picture of your stroke risk.
This article summarizes a single cross-sectional survey study and is for general information only. It does not establish that any medicine or lifestyle change prevents stroke. Do not start, stop, or change blood pressure medicine without talking to your doctor. If you notice sudden weakness, numbness, confusion, trouble speaking or seeing, or a severe headache, call emergency services right away.
This research translation is published by Gram Research, the science division of Gram, an AI-powered nutrition tracking app.