Abstract
Introduction: Blood pressure (BP) control may decline with age and degree of decline may differ by sex. Methods: The Multi-Ethnic Study of Atherosclerosis (MESA) recruited 6814 men and women, age 45 to 84 years, from six communities in the U.S. during 2000-2002 and follow-up exams occurred every two years for a total of 6 exams from 2000-2016. We assessed the association of age and sex with hypertension control using MESA data among participants receiving treatment for hypertension at any of the first five exams At each exam, resting BP was measured in triplicate at 1-minute intervals using an automated oscillometric device; we used the mean of last two measurements. Hypertension control was defined as BP < 140/90 mmHg among adults with treated hypertension. Mixed-effects models were used to examine the association of sex with BP control by age group (45-64, 65-84, 85+ yrs) while accounting for the clustering within sites and intra-individual correlation and adjusting for demographics, co-morbidities, smoking, alcohol use, and education. Results: Among the 2,017 adults receiving treatment for hypertension (63.1% controlled), the mean age at exam 1 was 64.0 (9.1) yrs, 43.3% male; race/ethnicity was 33.5% White, 9.2% Chinese, 37.2% Black and 20.1% Hispanic. There was a significant interaction of sex*age group (P < 0.001) in mixed-effects models after adjustment for all covariates. The adjusted probability of BP control was then calculated for each sex and age group. Among women, the probability of BP control declined from 74.6% (95% CI 70.8%, 78.5%) for age 45-64 yrs to 55.9% (50.0%, 61.8%) for age 85+ yrs. Among men, probability of BP control declined from 74.0% (70.0%, 78.0%) for age 45-64 yrs to 70.6% (65.7%, 75.5%) for age 85+ yrs. The figure shows the probability of hypertension control by sex and age at a given exam. Conclusion: Hypertension control differs by sex. Interventions are needed to address age-related sex disparities in hypertension control.
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