Abstract MP17: Cumulative Risks for Hypertension In Middle-Aged White and African American Men and Women

Abstract

Intro: Despite the high prevalence of hypertension (HTN) and the disproportionate burden of HTN-related diseases in African Americans (AA), the long-term risks for incident HTN for AA men and women, compared with whites, are poorly described. Methods: We conducted an individual-level pooled analysis of participants from The Atherosclerosis Risk in Communities and The Framingham Offspring Studies with baseline prevalence and follow-up data on HTN and medication use. HTN was defined as elevated levels and/or medication use at ≥2 consecutive exams. We quantified the long-term risk for stage I (untreated BP≥140/90 mm Hg), stage II (untreated BP≥160/100 mm Hg) and ≥ Stage I HTN or blood pressure medication use separately, using competing risk models to assess incidence from index age 55 years (y) through age 70y to 85y, adjusted for baseline prevalence and competing risks of death. Analyses were stratified by race and sex. Results: There were 11,405 White and 2,886 AA participants (55% and 64% female, respectively) included in the analysis. At index age 55y, the mean (SD) BMIs in white and AA (men/women), respectively, were 27.8(4.1)/26.9(5.6) and 28.1(5)/31.3(6.7) kg/m2. African Americans had higher baseline prevalence and higher overall long-term risks for HTN than Whites. Through age 70y, AA women had risks as high as 82.1% (95% CI: 79.2, 85.0), and white men had risks of 61.4% (95% CI: 59.5, 63.3). The overall rate of incident HTN development (over follow-up time) appears similar across groups; differences in long-term risk are attributable to substantial disparities in the prevalence of HTN by age 55y in this sample. Conclusions: Cumulative risks for HTN are very high in all groups, particularly in AA women. The earlier onset of HTN at high rates in AA men and women underscores the necessity of aggressive primordial prevention efforts early in the life course to reduce the massive population burden of HTN and HTN-related diseases.