Factors Associated With the Prevalence of Hypertension in the Southeastern United States

Abstract

33 H ypertension is a well-established risk factor for all-cause and cardiovascular disease (CVD) mortality, accounting for an estimated 7.5 million deaths per year or 13.5% of total annual deaths worldwide. 1,2 The public health significance of hypertension provided the impetus for the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7). 3 Moreover, in the report of the recent landmark Global Burden of Disease Study, hypertension now tops the list of risk factors for death and disability worldwide, 4 further highlighting the need to bet-ter characterize the risk factors for hypertension, specifically unreported and uncontrolled hypertension. Substantial evidence indicates that blacks have a higher prevalence of hyperten-sion than whites 5–7 and that severe hypertension and hyperten-sion complicated by target organ damage are more common in blacks and lead to higher rates of CVD and adverse events. 8 Black and white hypertensive patients have also been noted to have differential response to therapeutic strategies, comprising dietary interventions 9 and antihypertensive drugs, 10–12 including modulators of the renin-aldosterone-angiotensin system. 13–17 Recent efforts to determine reasons for racial disparities in the prevalence of hypertension and related adverse sequelae have included assessments of the impact of socioeconomic status (SES), including social environment. 18–25 In this context, Background—Lifestyle and socioeconomic status have been implicated in the prevalence of hypertension; thus, we evaluated factors associated with hypertension in a cohort of blacks and whites with similar socioeconomic status characteristics. Methods and Results—We evaluated the prevalence and factors associated with self-reported hypertension (SR-HTN) and ascertained hypertension (A-HTN) among 69 211 participants in the Southern Community Cohort Study. Multivariable logistic regression models were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for factors associated with hypertension. The prevalence of SR-HTN was 57% overall. Body mass index was associated with SR-HTN in all race-sex groups, with the OR rising to 4.03 (95% CI, 3.74–4.33) for morbidly obese participants (body mass index, >40 kg/m 2). Blacks were more likely to have SR-HTN than whites (OR, 1.84; 95% CI, 1.75–1.93), and the association with black race was more pronounced among women (OR, 2.08; 95% CI, 1.95–2.21) than men (OR, 1.47; 95% CI, 1.36–1.60). Similar findings were noted in the analysis of A-HTN. Among those with SR-HTN and A-HTN who reported use of an antihypertensive agent, 94% were on at least one of the major classes of antihypertensive agents, but only 44% were on ≥2 classes and only 29% were on a diuretic. The odds of both uncontrolled hypertension (SR-HTN and A-HTN) and unreported hypertension (no SR-HTN and A-HTN) were twice as high among blacks as whites (OR, 2.13; 95% CI, 1.68–2.69; and OR, 1.99; 95% CI, 1.59–2.48, respectively). Conclusions—Despite socioeconomic status similarities, we observed suboptimal use of antihypertensives in this cohort and racial differences in the prevalence of uncontrolled and unreported hypertension, which merit further investigation. (Circ Cardiovasc Qual Outcomes. 2014;7:33-54.)