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  • 1
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    Online Resource
    Social Determinants of Health and Uncontrolled Blood Pressure in a National Cohort of Black and White US Adults: the REGARDS Study
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Hypertension Vol. 80, No. 7 ( 2023-07), p. 1403-1413
    Details
    In: Hypertension, Ovid Technologies (Wolters Kluwer Health), Vol. 80, No. 7 ( 2023-07), p. 1403-1413
    Abstract: Determining the contribution of social determinants of health (SDOH) to the higher proportion of Black adults with uncontrolled blood pressure (BP) could inform interventions to improve BP control and reduce cardiovascular disease. Methods: We analyzed data from 7306 White and 7497 Black US adults taking antihypertensive medication from the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study (2003–2007). SDOH were defined using the Healthy People 2030 domains of education, economic stability, social context, neighborhood environment, and health care access. Uncontrolled BP was defined as systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg. Results: Among participants taking antihypertensive medication, 25.4% of White and 33.7% of Black participants had uncontrolled BP. The SDOH included in the current analysis mediated the Black-White difference in uncontrolled BP by 33.0% (95% CI, 22.1%–46.8%). SDOH that contributed to excess uncontrolled BP among Black compared with White adults included low annual household income (percent-mediated 15.8% [95% CI, 10.8%–22.8%]), low education (10.5% [5.6%–15.4%] ), living in a health professional shortage area (10.4% [6.5%–14.7%]), disadvantaged neighborhood (11.0% [4.4%–18.0%] ), and high-poverty zip code (9.7% [3.8%–15.5%]). Together, the neighborhood-domain accounted for 14.1% (95% CI, 5.9%–22.9%), the health care domain accounted for 12.7% (95% CI, 8.4%–17.3%), and the social-context-domain accounted for 3.8% (95% CI, 1.2%–6.6%) of the excess likelihood of uncontrolled BP among Black compared with White adults, respectively. Conclusions: SDOH including low education, low income, living in a health professional shortage area, disadvantaged neighborhood, and high-poverty zip code contributed to the excess likelihood of uncontrolled BP among Black compared with White adults.
    Type of Medium: Online Resource
    ISSN: 0194-911X , 1524-4563
    URL: Article
    DOI: 10.1161/HYPERTENSIONAHA.122.20219
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
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  • 2
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    Underutilization of Treatment for Black Adults With Apparent Treatment-Resistant Hypertension : JHS and the REGARDS Study
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Hypertension Vol. 76, No. 5 ( 2020-11), p. 1600-1607
    Details
    In: Hypertension, Ovid Technologies (Wolters Kluwer Health), Vol. 76, No. 5 ( 2020-11), p. 1600-1607
    Abstract: Resistant hypertension, defined as blood pressure levels above goal while taking ≥3 classes of antihypertensive medication or ≥4 classes regardless of blood pressure level, is associated with increased cardiovascular disease risk. The 2018 American Heart Association Scientific Statement on Resistant Hypertension recommends healthy lifestyle habits and thiazide-like diuretics and mineralocorticoid receptor antagonists for adults with resistant hypertension. The term apparent treatment-resistant hypertension (aTRH) is used when pseudoresistance cannot be excluded. We estimated the use of healthy lifestyle factors and recommended antihypertensive medication classes among US Black adults with aTRH. Data were pooled for Black participants in the JHS (Jackson Heart Study) in 2009 to 2013 (n=2496) and the REGARDS study (Reasons for Geographic and Racial Differences in Stroke) in 2013 to 2016 (n=3786). Outcomes included lifestyle factors (not smoking, not consuming alcohol, ≥75 minutes of vigorous-intensity or ≥150 minutes of moderate or vigorous physical activity per week, and body mass index 〈 25 kg/m 2 ) and recommended antihypertensive medications (thiazide-like diuretics and mineralocorticoid receptor antagonists). Overall, 28.3% of participants who reported taking antihypertensive medication had aTRH. Among participants with aTRH, 14.5% and 1.2% had ideal levels of 3 and 4 of the lifestyle factors, respectively. Also, 5.9% of participants with aTRH reported taking a thiazide-like diuretic, and 9.8% reported taking a mineralocorticoid receptor antagonist. In conclusion, evidence-based lifestyle factors and recommended pharmacological treatment are underutilized in Black adults with aTRH. Increased use of lifestyle recommendations and antihypertensive medication classes specifically recommended for aTRH may improve blood pressure control and reduce cardiovascular disease–related morbidity and mortality among US Black adults. Graphic Abstract A graphic abstract is available for this article.
    Type of Medium: Online Resource
    ISSN: 0194-911X , 1524-4563
    URL: Article
    DOI: 10.1161/HYPERTENSIONAHA.120.14836
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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  • 3
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    Online Resource
    Potential impact of systematic and random errors in blood pressure measurement on the prevalence of high office blood pressure in the United States
    Wiley ; 2022
    In:  The Journal of Clinical Hypertension Vol. 24, No. 3 ( 2022-03), p. 263-270
    Details
    In: The Journal of Clinical Hypertension, Wiley, Vol. 24, No. 3 ( 2022-03), p. 263-270
    Abstract: The authors examined the proportion of US adults that would have their high blood pressure (BP) status changed if systolic BP (SBP) and diastolic BP (DBP) were measured with systematic bias and/or random error versus following a standardized protocol. Data from the 2017–2018 National Health and Nutrition Examination Survey (NHANES; n  = 5176) were analyzed. BP was measured up to three times using a mercury sphygmomanometer by a trained physician following a standardized protocol and averaged. High BP was defined as SBP ≥130 mm Hg or DBP ≥80 mm Hg. Among US adults not taking antihypertensive medication, 32.0% (95%CI: 29.6%,34.4%) had high BP. If SBP and DBP were measured with systematic bias, 5 mm Hg for SBP and 3.5 mm Hg for DBP higher and lower than in NHANES, the proportion with high BP was estimated to be 44.4% (95%CI: 42.6%,46.2%) and 21.9% (95%CI 19.5%,24.4%). Among US adults taking antihypertensive medication, 60.6% (95%CI: 57.2%,63.9%) had high BP. If SBP and DBP were measured 5 and 3.5 mm Hg higher and lower than in NHANES, the proportion with high BP was estimated to be 71.8% (95%CI: 68.3%,75.0%) and 48.4% (95%CI: 44.6%,52.2%), respectively. If BP was measured with random error, with standard deviations of 15 mm Hg for SBP and 7 mm Hg for DBP, 21.4% (95%CI: 19.8%,23.0%) of US adults not taking antihypertensive medication and 20.5% (95%CI: 17.7%,23.3%) taking antihypertensive medication had their high BP status re‐categorized. In conclusions, measuring BP with systematic or random errors may result in the misclassification of high BP for a substantial proportion of US adults.
    Type of Medium: Online Resource
    ISSN: 1524-6175 , 1751-7176
    URL: Issue
    URL: Article
    DOI: 10.1111/jch.v24.3
    DOI: 10.1111/jch.14418
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2058690-5
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  • 4
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    Online Resource
    Abstract 59: Social Determinants of Health and Incident Apparent Treatment Resistant Hypertension in a National Cohort of Black and White US Adults
    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: Identifying social determinants of health (SDOH) associated with incident apparent treatment resistant hypertension (aTRH) may guide interventions to reduce the incidence of aTRH and its associated cardiovascular disease risk. Methods: We analyzed data from 2,769 White and 2,254 Black US adults from the REasons for Geographic and Racial Differences in Stroke study taking antihypertensive medication with controlled blood pressure (BP) at baseline to estimate the association of SDOH with incident aTRH. SDOH were guided by the Healthy People 2030 domains of education, economic stability, social context, neighborhood environment and healthcare access. Incident aTRH was defined as systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg, systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg for those with diabetes or chronic kidney disease, while taking ≥3 classes of antihypertensive medication or taking ≥4 classes of antihypertensive medication regardless of BP level, at a follow-up visit. Results: Over a median 9.5 years of follow-up, 16.1% of White versus 23.7% of Black adults developed aTRH. After age and sex adjustment, the SDOH associated with incident aTRH (hazard ratio; 95% CI) included having less than a high school education (1.51; 1.22 - 1.87), being a high school graduate (1.30; 1.10 - 1.53), and attending some college (1.29; 1.10 - 1.52) versus college graduate; annual household income 〈 $20,000 (1.83; 1.46 - 2.30), $20,000 to 〈 $35,000 (1.53; 1.23 - 1.90) and $35,000 to 〈 $75,000 (1.24; 1.00 - 1.53) versus ≥$75,000; having no one to care for you if ill (1.29; 1.08 - 1.55); living in a disadvantaged neighborhood in quartiles 1 (1.72; 1.42 - 2.08) and 2 (1.48; 1.22 - 1.80) versus 4, or a high poverty zip code (1.26; 1.09 - 1.47); not having health insurance (1.36; 1.06 - 1.74) and residing in a state with low public health infrastructure (1.17; 1.02 - 1.33). Results stratified by race are presented in the Table. Conclusion: SDOH were associated with transitioning from controlled BP to incident aTRH among White and Black adults.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.147.suppl_1.59
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 1466401-X
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  • 5
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    Online Resource
    Cardiovascular Health and Transition From Controlled Blood Pressure to Apparent Treatment Resistant Hypertension : The Jackson Heart Study and the REGARDS Study
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Hypertension Vol. 76, No. 6 ( 2020-12), p. 1953-1961
    Details
    In: Hypertension, Ovid Technologies (Wolters Kluwer Health), Vol. 76, No. 6 ( 2020-12), p. 1953-1961
    Abstract: Almost 1 in 5 US adults with hypertension has apparent treatment resistant hypertension (aTRH). Identifying modifiable risk factors for incident aTRH may guide interventions to reduce the need for additional antihypertensive medication. We evaluated the association between cardiovascular health and incident aTRH among participants with hypertension and controlled blood pressure (BP) at baseline in the Jackson Heart Study (N=800) and the Reasons for Geographic and Racial Differences in Stroke study (N=2316). Body mass index, smoking, physical activity, diet, BP, cholesterol and glucose, categorized as ideal, intermediate, or poor according to the American Heart Association’s Life’s Simple 7 were assessed at baseline and used to define cardiovascular health. Incident aTRH was defined by uncontrolled BP, systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg, while taking ≥3 classes of antihypertensive medication or controlled BP, systolic BP 〈 130 mm Hg and diastolic BP 〈 80 mm Hg, while taking ≥4 classes of antihypertensive medication at a follow-up visit. Over a median 9 years of follow-up, 605 (19.4%) participants developed aTRH. Incident aTRH developed among 25.8%, 18.2%, and 15.7% of participants with 0 to 1, 2, and 3 to 5 ideal Life’s Simple 7 components, respectively. No participants had 6 or 7 ideal Life’s Simple 7 components at baseline. The multivariable adjusted hazard ratios (95% CIs) for incident aTRH associated with 2 and 3 to 5 versus 0 to 1 ideal components were 0.75 (0.61–0.92) and 0.67 (0.54–0.82), respectively. These findings suggest optimizing cardiovascular health may reduce the pill burden and high cardiovascular risk associated with aTRH among individuals with hypertension.
    Type of Medium: Online Resource
    ISSN: 0194-911X , 1524-4563
    URL: Article
    DOI: 10.1161/HYPERTENSIONAHA.120.15890
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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  • 6
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    Online Resource
    Abstract 052: Social Determinants Of Health And Uncontrolled Blood Pressure In A National Cohort Of Black And White US Adults
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation Vol. 145, No. Suppl_1 ( 2022-03)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 145, No. Suppl_1 ( 2022-03)
    Abstract: Background: Hypertension and uncontrolled blood pressure (BP) are the largest contributors to racial disparities in life expectancy. Determining the contribution of social determinants of health (SDOH) to racial differences in uncontrolled BP could help identify ways to achieve the American Heart Association’s 2030 impact goal of equitably improving healthy life expectancy. Methods: We analyzed data from 7,497 Black and 7,306 White US adults taking antihypertensive medication from the REasons for Geographic and Racial Differences in Stroke study to determine the association between SDOH and uncontrolled BP. SDOH were defined using the Healthy People 2030 domains of education, economic stability, social context, neighborhood environment and healthcare access. Uncontrolled BP was defined as systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg. Results: Among participants taking antihypertensive medication (mean age 66.3 years, 50.7% Black, 57.1% female), 68.0% of Black and 59.0% of White participants had uncontrolled BP. After multivariable adjustment, uncontrolled BP (prevalence ratio; 95% CI) was more common among those with less than a high school education (1.06; 1.02 – 1.09), annual household income 〈 $20,000 (1.12; 1.06 – 1.18) and $20,000 to 〈 $35,000 (1.09; 1.04 – 1.15) versus ≥$75,000; without health insurance (1.08; 1.03 – 1.14) and residing in a disadvantaged neighborhood (1.04; 1.01 – 1.07), a zip code with high poverty (1.03; 1.00 – 1.07) or a health professional shortage area (1.07; 1.05 – 1.10). For each SDOH, the proportion of participants with uncontrolled BP was higher among Black compared with White adults. After multivariable adjustment, having a higher number of adverse SDOH was associated with a higher prevalence of uncontrolled BP among both Black and White adults (Table). Conclusion: SDOH were associated with uncontrolled BP among both Black and White adults taking antihypertensive medication.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.145.suppl_1.052
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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  • 7
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    Online Resource
    Number and timing of ambulatory blood pressure monitoring measurements
    Springer Science and Business Media LLC ; 2021
    In:  Hypertension Research Vol. 44, No. 12 ( 2021-12), p. 1578-1588
    Details
    In: Hypertension Research, Springer Science and Business Media LLC, Vol. 44, No. 12 ( 2021-12), p. 1578-1588
    Type of Medium: Online Resource
    ISSN: 0916-9636 , 1348-4214
    URL: Article
    DOI: 10.1038/s41440-021-00717-y
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2110941-2
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  • 8
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    Abstract TMP97: Temporal Trends in Black-White Differences of Antihypertensive Treatment in Individuals With and Without History of Stroke: Reasons for Geographic and Racial Differences in Stroke (REGARDS)
    Ovid Technologies (Wolters Kluwer Health) ; 2024
    In:  Stroke Vol. 55, No. Suppl_1 ( 2024-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 55, No. Suppl_1 ( 2024-02)
    Abstract: Introduction: In 2014, the Eighth Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC8) included race-specific recommendations for antihypertensive treatments (e.g. calcium channel blockers [CCBs] for Black persons). The impact of these guidelines on anti-hypertensive regimen changes over time, and if this varied by prevalent stroke status, is unclear. Methods: REGARDS participants reporting anti-hypertensive medications with and without history of stroke who completed an in-home examination in 2003-2007 (Visit 1) or 2013-2016 (Visit 2) were included. Logistic regression mixed models estimated odds ratios (OR) and 95% confidence intervals (CI) for use of each antihypertensive class for Visit 2 vs. Visit 1 and Black vs. White with interaction by prevalent stroke status, adjusted for demographic and socioeconomic status. Results: Of 17,222 participants without prevalent stroke at Visit 1, Black participants had greater odds of ACE-inhibitor usage relative to White participants (OR 1.68, 95% CI 1.44-1.95). This difference remained but was smaller in 7,476 participants without stroke at Visit 2 (OR 1.29, CI 1.20-1.38). In participants without prevalent stroke, lower odds of CCB usage among Black compared to White participants was observed at Visit 1 (OR 0.47, CI 0.41-0.55) but there was no difference at Visit 2 (OR 1.00, CI 0.94-1.07). Among 1,436 participants with prevalent stroke at Visit 1, Black participants had lower odds of CCB use compared to White participants (OR 0.48, CI 0.29-0.82) but similar odds in 689 participants with prevalent stroke at Visit 2 (OR 1.15, CI 0.91-1.44). Conclusions: Consistent with JNC8 recommendations for first-line medication administration in Black persons with hypertension, there was a higher likelihood of CCB use over time among Black participants in REGARDS. Adherence to race-based guidance for antihypertensive medication may be increasing over time.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.55.suppl_1.TMP97
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2024
    detail.hit.zdb_id: 1467823-8
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  • 9
    Online Resource
    Online Resource
    Racial Differences in Blood Pressure Control Following Stroke: The REGARDS Study
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Stroke Vol. 52, No. 12 ( 2021-12), p. 3944-3952
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 52, No. 12 ( 2021-12), p. 3944-3952
    Abstract: In the general population, Black adults are less likely than White adults to have controlled blood pressure (BP), and when not controlled, they are at greater risk for stroke compared with White adults. High BP is a major modifiable risk factor for recurrent stroke, but few studies have examined racial differences in BP control among stroke survivors. Methods: We used data from the REGARDS study (Reasons for Geographic and Racial Differences in Stroke) to examine disparities in BP control between Black and White adults, with and without a history of stroke. We studied participants taking antihypertensive medication who did and did not experience an adjudicated stroke (n=306 and 7693 participants, respectively) between baseline (2003–2007) and a second study visit (2013–2016). BP control at the second study visit was defined as systolic BP 〈 130 mm Hg and diastolic BP 〈 80 mm Hg except for low-risk adults ≥65 years of age (ie, those without diabetes, chronic kidney disease, history of cardiovascular disease, and with a 10-year predicted atherosclerotic cardiovascular disease risk 〈 10%) for whom BP control was defined as systolic BP 〈 130 mm Hg. Results: Among participants with a history of stroke, 50.3% of White compared with 39.3% of Black participants had controlled BP. Among participants without a history of stroke, 56.0% of White compared with 50.2% of Black participants had controlled BP. After multivariable adjustment, there was a tendency for Black participants to be less likely than White participants to have controlled BP (prevalence ratio, 0.77 [95% CI, 0.59–1.02] for those with a history of stroke and 0.92 [95% CI, 0.88–0.97] for those without a history of stroke). Conclusions: There was a lower proportion of controlled BP among Black compared with White adults with or without stroke, with no statistically significant differences after multivariable adjustment.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.120.033108
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
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