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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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    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
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  • 4
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    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
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  • 5
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    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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    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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    Treatment-related Correlates of Growth in Children With Sickle Cell Disease in the DISPLACE Cohort
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Journal of Pediatric Hematology/Oncology Vol. 44, No. 5 ( 2022-07), p. 249-254
    Details
    In: Journal of Pediatric Hematology/Oncology, Ovid Technologies (Wolters Kluwer Health), Vol. 44, No. 5 ( 2022-07), p. 249-254
    Abstract: Reduced growth and delayed maturation have been described in children with sickle cell disease (SCD). This study investigated growth and hemolysis in children with SCD in the DISPLACE (Dissemination and Implementation of Stroke Prevention Looking at the Care Environment) cohort. The database includes 5287 children, of which, 3305 had at least 2 growth measurements over a 5-year period. Body mass index was converted to z-scores (zBMI), and 19.8%, 66.1%, 14.2% of children were classified as underweight, normal, and overweight/obese, respectively. Multivariable analysis of growth was conducted and included variables: age, sex, blood pressure, hemoglobin, reticulocyte count, treatment with chronic red cell transfusion therapy (CRCT), or hydroxyurea therapy. Baseline hemoglobin levels were associated with the lower odds of being underweight (odds ratio [OR]=0.93, 95% confidence interval [CI] : 0.86-0.99), and higher odds of being overweight/obese (OR: 1.26, 95% CI: 1.17-1.36) compared with normal zBMI. CRCT was associated with being overweight/obese at baseline (OR: 1.85, 95% CI: 1.31-2.60). Overall, results showed that children who were underweight improved regardless of therapy over the 2-year time period. However, children on CRCT are at higher risk for being overweight and should be monitored closely.
    Type of Medium: Online Resource
    ISSN: 1077-4114
    URL: Article
    DOI: 10.1097/MPH.0000000000002296
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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  • 8
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    Abstract 11263: Multiple Inflammation Biomarkers and Incident Coronary Heart Disease Risk Among Black and White US Adults: The REGARDS Study
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Circulation Vol. 144, No. Suppl_1 ( 2021-11-16)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 144, No. Suppl_1 ( 2021-11-16)
    Abstract: Introduction: Inflammation biomarkers have been individually associated with increased risk of coronary heart disease (CHD). However, little is known of the association between multiple inflammation biomarker counts in the high-risk category and incident CHD risk. Methods: We used data from the REasons for Geographic and Racial Differences in Stroke study, an ongoing national cohort of 30,239 Black and White US adults aged ≥45 years recruited in 2003-2007. Baseline levels of C-reactive protein (hsCRP), white blood cell count (WBC) and serum albumin were divided into tertiles. High-risk categories of hsCRP and WBC were defined as levels above the 3 rd tertile (3.75 mg/dL and 6.31 x 10 9 cells/L, respectively) and albumin levels below the 1 st tertile (4.0 g/dL). Four mutually exclusive groups were derived corresponding to having 0, 1, 2 or 3 biomarkers in the high-risk category. Outcome was a composite of incident non-fatal myocardial infarction and fatal CHD. Results: Of 15,738 participants free of CHD at baseline (mean age 63.1 years, 65.3% female, 40.8% black), 38.9% (n = 6,121) had 0, 36.6% (n = 5,765) had 1, 19.7% (n = 3,107) had 2, 4.7% (n = 745) had 3 inflammation biomarkers in the elevated levels. With median follow-up of 10.5 years, 902 (5.7%) participants had incident CHD. The rates of incident CHD and 95% confidence intervals (CI) per 1000 person years increased progressively for individuals with 0, 1, 2, and 3 inflammation biomarkers in the high-risk category: 4.4 (95% CI: 3.9-5.0), 6.3 (95% CI: 5.7-7.0), 8.9 (95% CI: 7.8-10.0), and 10.3 (95% CI: 7.7-12.8), respectively. The fully adjusted hazard ratios (95% CI) for incident CHD associated with 1, 2 and 3 versus no inflammation biomarker in the high-risk category were 1.28 (1.08-1.51), 1.71 (1.42-2.06), and 1.90 (1.43-2.54), respectively (P trend 〈 0.001) (Table). Conclusions: The count of inflammation biomarkers in the high-risk category is associated with increased risk of CHD independent of traditional risk factors.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.144.suppl_1.11263
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
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  • 9
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    Reasons for Uncontrolled Blood Pressure Among US Adults: Data From the US National Health and Nutrition Examination Survey
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Hypertension Vol. 78, No. 5 ( 2021-11), p. 1567-1576
    Details
    In: Hypertension, Ovid Technologies (Wolters Kluwer Health), Vol. 78, No. 5 ( 2021-11), p. 1567-1576
    Abstract: Identifying subgroups of the population with different reasons for uncontrolled blood pressure (BP) can inform where to direct interventions to increase hypertension control. We determined characteristics associated with not being aware of having hypertension and being aware but not treated with antihypertensive medication among US adults with uncontrolled BP using the 2015 to 2018 National Health and Nutrition Examination Surveys (N=2282). Among US adults with uncontrolled BP, systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg, 38.0% were not aware they had hypertension, 15.6% were aware but not treated and 46.4% were aware and treated with antihypertensive medication. After multivariable adjustment, US adults who were 18-39 versus ≥70 years old were more likely (prevalence ratio, 1.49 [95% CI, 1.11–1.99]) and those who had a health care visit in the past year were less likely (prevalence ratio, 0.61 [95% CI, 0.48–0.77] ) to be unaware they had hypertension. Among US adults with uncontrolled BP who were aware they had hypertension, those 18 to 39, 40 to 49, 50 to 59, and 60 to 69 versus ≥70 years old were more likely to not be treated versus being treated with antihypertensive medication. Not being treated with antihypertensive medication versus being treated and having uncontrolled BP was less common among those with versus without a usual source of health care (prevalence ratio, 0.69 [95% CI, 0.51–0.94]) and who reported having versus not having a health care visit in past year (prevalence ratio, 0.46 [95% CI, 0.35–0.61] ). In conclusion, to increase BP control, interventions should be directed towards populations in which hypertension awareness is low and uncontrolled BP is common despite antihypertensive medication use.
    Type of Medium: Online Resource
    ISSN: 0194-911X , 1524-4563
    URL: Article
    DOI: 10.1161/HYPERTENSIONAHA.121.17590
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
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  • 10
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    Maintaining Normal Blood Pressure Across the Life Course : The JHS
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Hypertension Vol. 77, No. 5 ( 2021-05), p. 1490-1499
    Details
    In: Hypertension, Ovid Technologies (Wolters Kluwer Health), Vol. 77, No. 5 ( 2021-05), p. 1490-1499
    Abstract: Although mean blood pressure (BP) increases with age, there may be a subset of individuals whose BP does not increase with age. Characterizing the population that maintains normal BP could inform hypertension prevention efforts. We determined the proportion of Jackson Heart Study participants that maintained normal BP at 3 visits over a median of 8 years. Normal BP was defined as systolic BP 〈 120 mm Hg and diastolic BP 〈 80 mm Hg without antihypertensive medication. We identified lifestyle and psychosocial factors associated with maintaining normal BP and calculated the incidence rate for cardiovascular disease (CVD). Overall, 757 of 3432 participants (22.1%) had normal BP at baseline, and 262 of these participants (34.6%) maintained normal BP. Among participants with normal BP at baseline, normal body mass index (risk ratio [RR] 1.37 [95% CI, 1.08–1.75] ), ideal physical activity (RR, 1.28 [95% CI, 0.99–1.65]), and never smoking (RR, 1.48 [95% CI, 0.99–2.20] ) at baseline were associated with maintaining normal BP. Maintaining normal body mass index (RR, 1.42 [95% CI, 1.10–1.84]) and ideal physical activity (RR, 1.51 [95% CI, 1.18–1.94] ) at all study visits were associated with maintaining normal BP. The cardiovascular disease incidence rate was 4.5, 6.3, and 16.4 per 1000 person-years among participants who maintained normal BP, had normal BP at baseline but did not maintain normal BP, and had elevated BP or hypertension at baseline, respectively, over 5.9 years of follow-up. These data suggest that maintaining normal body mass index and ideal physical activity are potential approaches for African American adults to maintain normal BP.
    Type of Medium: Online Resource
    ISSN: 0194-911X , 1524-4563
    URL: Article
    DOI: 10.1161/HYPERTENSIONAHA.120.16278
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
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