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  • 1
    Online Resource
    Online Resource
    Abstract P091: Reasons For Uncontrolled Blood Pressure Among US Adults
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Circulation Vol. 143, No. Suppl_1 ( 2021-05-25)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 143, No. Suppl_1 ( 2021-05-25)
    Abstract: Introduction: In October 2020, the US Surgeon General issued a Call to Action on hypertension control. We investigated the contribution of lack of awareness, not taking antihypertensive medication and an inadequate antihypertensive medication regimen to uncontrolled blood pressure (BP) among US adults. Methods: We analyzed data for 2,282 participants ≥18 years of age with uncontrolled BP from the 2015-2016 and 2017-2018 National Health and Nutrition Examination Surveys (NHANES). BP was measured three times by a trained physician following a standardized protocol. Uncontrolled BP was defined by systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg. Being aware of having hypertension and antihypertensive medication use were defined by self-report. An inadequate antihypertensive medication regimen was defined as taking antihypertensive medication with uncontrolled BP. Data were weighted to represent the non-institutionalized US population. Results: Among US adults with uncontrolled BP, 34.8% were not aware they had hypertension, 13.8% were aware but not taking antihypertensive medication and 51.4% were aware but taking inadequate antihypertensive medication regimen. US adults 18-39 and 40-49 years of age were more likely to be unaware they had hypertension compared to their counterparts ≥70 years of age (multivariable-adjusted prevalence ratios [PR]: 1.62 [95% CI: 1.26-2.07] and 1.41 [95% CI: 1.02-1.95], respectively). Participants who had a healthcare visit in the past year (PR: 0.60 [95% CI: 0.47-0.77] ) and who were obese (PR: 0.69 [95% CI: 0.56-0.85]), had diabetes (PR: 0.56 [95% CI: 0.42-0.76] ), chronic kidney disease (PR: 0.59 [95% CI: 0.46-0.75]) and a history of cardiovascular disease (PR: 0.41 [95% CI: 0.27-0.61] ) were less likely to be unaware they had hypertension. Among those who were aware they had hypertension, US adults who were 18-39 and 40-49 years of age as compared to those ≥70 years of age were more likely to be not taking antihypertensive medication versus taking inadequate antihypertensive medication regimen (multivariable-adjusted PR: 5.48 [95% CI: 3.17-9.48] and 5.14 [95% CI: 2.28-10.26] , respectively). In contrast, non-Hispanic blacks and Hispanics as compared to non-Hispanic whites (PR: 0.71 [95% CI: 0.53-0.94] and 0.72 [95% CI: 0.54-0.96] , respectively) and those without a usual place to receive healthcare (PR: 0.70 [95% CI 0.51-0.96]) and who had a healthcare visit in past year (PR: 0.47 [95% CI: 0.35-0.62] ) were less likely to be not taking antihypertensive medication versus taking inadequate antihypertensive medication regimen. Conclusion: The majority of US adults with uncontrolled BP were either unaware they had hypertension or were taking an inadequate antihypertensive medication regimen. Interventions are needed to increase hypertension awareness and assess and titrate patients’ antihypertensive medication regimen.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.143.suppl_1.P091
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 1466401-X
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  • 2
    Online Resource
    Online Resource
    Abstract P335: Using Cardiovascular Disease Risk Versus Blood Pressure To Guide The Initiation Of Antihypertensive Medication Among Us Adults
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Circulation Vol. 141, No. Suppl_1 ( 2020-03-03)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 141, No. Suppl_1 ( 2020-03-03)
    Abstract: Introduction: The primary goal of initiating antihypertensive medication is to prevent cardiovascular disease (CVD). It has been hypothesized that using CVD risk to guide the decision to initiate antihypertensive medication may prevent more CVD events than treatment guided by blood pressure (BP) alone. Methods: We estimated the number of CVD and all-cause deaths that could be prevented among US adults through the initiation of antihypertensive medication based on high CVD risk versus high BP. CVD and all-cause mortality rates were calculated using data from 4,390 participants 40 to 79 years of age not taking antihypertensive medication from the 1999 to 2004 National Health and Nutrition Examination Survey (NHANES) mortality follow-up study. High BP was defined by systolic BP ≥ 140 mm Hg or diastolic BP ≥ 90 mm Hg. High CVD risk was defined by 10-year predicted CVD risk ≥10% using the Pooled Cohort risk equations or a history of CVD. Relative risks and 95% confidence limits for CVD and all-cause mortality with antihypertensive medication of 0.75 (0.57-0.98) and 0.76 (0.63-0.91), respectively, were obtained from the Blood Pressure Lowering Treatment Trialists Collaboration. Results: Among US adults not taking antihypertensive medication, 19.4% (23.5 million) had high BP and 25.5% (30.9 million) had high CVD risk. CVD mortality rates were 5.3 and 3.9 per 1,000 person-years among US adults with high CVD risk versus high BP, respectively (Table). Using high CVD risk to guide antihypertensive medication initiation is projected to prevent 403,093 deaths from CVD over 10 years compared with 224,312 deaths from CVD projected to be prevented using a BP-guided treatment approach. More all-cause deaths are projected to be prevented by using high CVD risk (2.2 million deaths) rather than high BP (1.1 million deaths) to guide the decision to initiate antihypertensive medication. Conclusions: Using predicted CVD risk instead of BP alone to guide antihypertensive medication initiation is projected to prevent more CVD and all-cause deaths.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.141.suppl_1.P335
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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  • 3
    Online Resource
    Online Resource
    Abstract 064: Prevalence, Risk Factors And Cardiovascular Outcomes Associated With Persistent Blood Pressure Control: The Jackson Heart Study
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Circulation Vol. 143, No. Suppl_1 ( 2021-05-25)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 143, No. Suppl_1 ( 2021-05-25)
    Abstract: Introduction: Cross-sectional studies have reported the proportion of African-American adults with controlled blood pressure (BP) at a single time point, but few data are available on the proportion that maintains controlled BP over time and the extent to which it is associated with cardiovascular disease (CVD) risk. Methods: We analyzed data from 1,414 African-American Jackson Heart Study (JHS) participants taking antihypertensive medication to estimate the proportion with persistent BP control, defined by having controlled BP at the three JHS visits, conducted over a median of 8 years. At each visit, BP control was defined as systolic BP 〈 140 mm Hg and diastolic BP 〈 90 mm Hg. Follow-up for CVD events began after the third visit. We calculated risk ratios (RR) for factors associated with persistent BP control and hazard ratios (HR) for incident CVD events among participants with versus without persistent BP control. Results: At baseline, 76.5% (n=1,081) of participants had controlled BP, among which 64.4% (n=696) had persistent BP control. Overall, 49.2% (n=696) of participants had persistent BP control. After adjustment for sex, participants ≥65 compared with 〈 65 years of age were less likely (RR; 95% CI) to have persistent BP control (0.73; 0.64 - 0.83). After age and sex adjustment, participants were more likely to have persistent BP control if they had income ≥$25,000 a year at each study visit (1.25; 1.11 - 1.40), a high school education (1.20; 1.01 - 1.41) and health insurance (1.28; 1.05 - 1.57) at Visit 1, and visited a health professional in the past year at each study visit (1.21; 1.07 - 1.37). The multivariable adjusted HR (95% CI) comparing participants with versus without persistent BP control was 0.71 (0.45 - 1.14) for CVD, 0.85 (0.41 - 1.79) for coronary heart disease, 0.68 (0.28 - 1.64) for stroke, and 0.57 (0.33 - 0.98) for heart failure (HF) ( Table ). Conclusions: Less than half of JHS participants taking antihypertensive medication had persistent BP control, putting them at increased risk for CVD, particularly HF.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.143.suppl_1.064
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
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  • 4
    Online Resource
    Online Resource
    Abstract P258: Global Stress and Masked Hypertension in African-Americans: The Jackson Heart Study
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Circulation Vol. 147, No. Suppl_1 ( 2023-02-28)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 147, No. Suppl_1 ( 2023-02-28)
    Abstract: Background: Chronic stress experienced at home or work has been associated with acute increases in blood pressure (BP) measured in the doctor’s office, but few data are available on the association of chronic stress with BP measured outside of the office setting. Methods: We analyzed data from 473 African-American adults enrolled in the Jackson Heart Study with office BP 〈 130/80 mm Hg to examine the association between chronic stress and masked hypertension (MHT). Chronic stress related to jobs, relationships, neighborhoods, caregiving, legal problems, medical problems, racism and discrimination, and meeting basic needs experienced over the previous 12 months was assessed using the 8-item Global Perceived Stress Scale (GPSS). We grouped participants by tertile of the composite GPSS score. Any MHT was defined as awake BP ≥ 130/80 mm Hg, asleep BP ≥ 110/65 mm Hg, or 24-hour BP ≥ 125/75 mm Hg. Analyses were stratified by antihypertensive medication use. Results: Among participants not taking antihypertensive medication (mean age 53 years), the prevalence of any MHT was 59.0%, 75.0% and 61.8% for the low (GPSS score ≤ 3), middle (GPSS score 4 - 6), and upper tertiles of the GPSS score (GPSS score 〉 6), respectively. Among those taking antihypertensive medication (mean age 61 years), the prevalence of any MHT was 77.4%, 80.7%, and 77.9% for participants in the low, middle, and upper tertile of the GPSS score, respectively. After multivariable adjustment, the prevalence ratio (95% confidence interval) for any MHT associated with the middle and upper versus low tertile of the GPSS score was 1.23 (0.96, 1.57) and 1.07 (0.83, 1.39), respectively, among those not taking antihypertensive medication and 0.97 (0.82, 1.14) and 1.02 (0.85, 1.21), respectively, among those taking antihypertensive medication (Table). Conclusion: No association was present between chronic stress and MHT among African Americans in the Jackson Heart Study.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.147.suppl_1.P258
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
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  • 5
    Online Resource
    Online Resource
    Factors Associated With Not Having a Healthcare Visit in the Past Year Among US Adults With Hypertension: Data From NHANES 2013–2018
    Oxford University Press (OUP) ; 2022
    In:  American Journal of Hypertension Vol. 35, No. 2 ( 2022-02-01), p. 132-141
    Details
    In: American Journal of Hypertension, Oxford University Press (OUP), Vol. 35, No. 2 ( 2022-02-01), p. 132-141
    Abstract: Not having a healthcare visit in the past year has been associated with a higher likelihood of uncontrolled blood pressure (BP) among individuals with hypertension. Methods We examined factors associated with not having a healthcare visit in the past year among US adults with hypertension using data from the US National Health and Nutrition Examination Survey 2013–2018 (n = 5,985). Hypertension was defined as systolic BP (SBP) ≥140 mm Hg, diastolic BP (DBP) ≥90 mm Hg, or antihypertensive medication use. Having a healthcare visit in the past year was self-reported. Results Overall, 7.0% of US adults with hypertension reported not having a healthcare visit in the past year. Those without vs. with a healthcare visit in the past year were less likely to be aware they had hypertension (45.0% vs. 83.9%), to be taking antihypertensive medication (36.7% vs. 91.4%, among those who were aware they had hypertension), and to have controlled BP (SBP/DBP & lt;140/90 mm Hg; 9.1% vs. 51.7%). After multivariable adjustment, not having a healthcare visit in the past year was more common among US adults without health insurance (prevalence ratio [PR]: 2.22; 95% confidence interval [CI] 1.68–2.95), without a usual source of healthcare (PR: 5.65; 95% CI 4.16–7.67), who smoked cigarettes (PR: 1.34; 95% CI 1.02–1.77), and with heavy vs. no alcohol consumption (PR: 1.55; 95% CI 1.16–2.08). Also, not having a healthcare visit in the past year was more common among those without diabetes or a history of atherosclerotic cardiovascular disease, and those not taking a statin. Conclusions Interventions should be considered to ensure all adults with hypertension have annual healthcare visits.
    Type of Medium: Online Resource
    ISSN: 0895-7061 , 1941-7225
    URL: Article
    DOI: 10.1093/ajh/hpab153
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 1479505-X
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