Differences In Prevalence Of Hypertension Research Articles

Regional and rural-urban patterns in the prevalence of diagnosed hypertension among older U.S. adults with diabetes, 2005–2017

BackgroundHypertension prevalence among the overall US adult population has been relatively stable during the last two decades. However, whether this stabilization has occurred across rural-urban communities and across different geographic regions is unknown, particularly among older adults with diabetes who are likely to have concomitant cardiovascular risk factors.MethodsThis serial cross-sectional analysis used the 5% national sample of Medicare administrative claims data (n = 3,516,541) to examine temporal trends (2005–2017) in diagnosed hypertension among older adults with diabetes, across urban-rural communities and US census regions (Northeast, Midwest, South, and West). Joinpoint regression was used to obtain annual percent change (APC) in hypertension prevalence across rural-urban communities and geographic regions, and multivariable adjusted regression was used to assess associations between rural-urban communities and hypertension prevalence.ResultsThe APC in the prevalence of hypertension was higher during 2005–2010, and there was a slowdown in the increase during 2011–2017 across all regions, with significant variations across rural-urban communities within each of the regions. In the regression analysis, in the adjusted model, older adults living in non-core (most rural) areas in the Midwest (PR = 0.988, 95% CI: 0.981–0.995) and West (PR = 0.935, 95% CI: 0.923–0.946) had lower hypertension prevalence than their regional counterparts living in large central metro areas.ConclusionsAlthough the magnitudes of these associations are small, differences in hypertension prevalence across rural-urban areas and geographic regions may have implications for targeted interventions to improve chronic disease prevention and management.

Abstract 18650: Differences in Hypertension Prevalence, Awareness, and Treatment Between Sexual Minority and Heterosexual Adults in the All of Us Research Program

Introduction: Hypertension accounts for approximately half of cardiovascular disease morbidity and mortality globally. There is growing evidence that younger sexual minority (e.g., gay and bisexual) men and bisexual women report a higher prevalence of hypertension than their heterosexual counterparts. However, there is limited evidence on differences in hypertension prevalence, awareness, and treatment among sexual minority middle-aged and older adults. Therefore, we sought to examine differences in hypertension prevalence, awareness and treatment between sexual minority and heterosexual middle-aged and older adults. Hypothesis: Compared to heterosexual adults, sexual minority participants will: 1) have a higher prevalence of hypertension, 2) be less likely to be aware of their hypertension, and 3) be less likely to obtain hypertension treatment. Methods: We analyzed questionnaire, physical examination, and diagnostic data from the All of Us Research Program. We used sex-stratified multivariate logistic regression models to examine sexual identity differences in objective hypertension (i.e., a systolic blood pressure ≥ 130 and/or a diastolic blood pressure ≥ 80), hypertension awareness, and hypertension treatment among adults. Results: The sample included 53,582 participants with a mean age of 56.3 years (±16.4); 66% were female and 78% were non-Hispanic White. Among men who met objective criteria for hypertension, bisexual men were less likely to report they were unaware they had hypertension compared to heterosexual men (AOR = 0.67, 95% CI = 0.52-0.88). There were no differences in hypertension prevalence or hypertension treatment between sexual minority and heterosexual adults. Conclusions: This is the first study to use data from the All of Us Research Program to examine disparities in hypertension prevalence, treatment, and awareness among sexual minority middle-aged and older adults. We found few differences between sexual minority and heterosexual participants, which contradicts prior work that has largely focused on younger adults. Findings suggest that researchers should investigate factors that contribute to the narrowing of hypertension disparities among sexual minority adults as they age.

Abstract P162: Gender Differences In Hypertension Risk Factors In Non-hispanic Asian Adults In The United States

Introduction: Hypertension (HTN) is a leading cause of comorbidity and mortality worldwide. Limited studies discussed the risk prediction for HTN prevalence among non-Hispanic Asian adults. We aim to examine gender differences in HTN prevalence and associations between risk factors and hypertension in non-Hispanic Asian adults in the US. Methods: We included non-Hispanic Asian adults (≥20 years) from the 2017-2018 National Health and Nutrition Examination Surveys. HTN was defined as blood pressure ≥140/90 mmHg or self-reported use of antihypertensive medication. We used hierarchical logistic regression to determine the odds of HTN diagnosis for different gender groups. Results: Among the 811 participants, 29.60% of men (111 of 375) and 28.90% of women (126 of 436) had HTN. The study found that the odds of HTN diagnosis increased with age for both men and women. Men aged 30-80 years had greater odds of HTN diagnosis compared to those aged 20-29 years, with odds ranging from 14.85 to 124.85. Women aged 50-80 years had greater odds of HTN diagnosis compared to those aged 20-29 years, with odds ranging from 22.74 to 67.33 (Table). Body mass index was a stronger predictor of HTN among women than men. In men, a higher waist-to-height ratio was associated with increased odds of HTN diagnosis. In women, higher fasting blood glucose and serum uric acid levels were stronger predictors of HTN. Conclusion: This study discovered substantial gender differences in the risk factors for HTN among non-Hispanic Asian adults living in the United States, with age shown to be a major risk factor.

Epidemiological survey of hypertension among middle-aged and elderly adults in Anhui Province.

To understand and analyze the prevalence and treatment of hypertension among residents aged 45 years and older in northern and southern Anhui Province to provide an opportunity to improve awareness, taking into account and standardizing hypertension management. Using a stratified cluster random sampling method, Anhui Province was divided into northern and southern Anhui regions using the Yangtze River as the boundary. The prevalence rate, awareness rate, treatment rate, control rate, related risk factors and complications of hypertension in the community population aged ≥ 45 years in Anhui Province were investigated using a questionnaire survey and a physical examination. The chi-square test was used to analyze the regional differences in hypertension prevalence, awareness, treatment and control rates. Weighted logistic regression was used to analyze the risk factors for hypertension. A total of 1331 residents aged ≥ 45 years were included. The results showed that the overall prevalence of hypertension in the Anhui Province population aged ≥ 45 years was 47.48% (50.73% in northern Anhui and 43.21% in southern Anhui), and the prevalence of hypertension in northern Anhui was higher than that in southern Anhui. The survey showed that the overall hypertension awareness rate in Anhui Province was 59.67%, the hypertension treatment rate was 44.46%, and the hypertension control rate was 30.70%. The differences between the 2 regions was statistically significant. The hypertension awareness, treatment and control rates in southern Anhui were higher than those in northern Anhui (P < .05). The risk factors for hypertension were older age, rural residence, male, obesity, low education level, high salt diet, smoking, excessive drinking, poor sleep, insufficient exercise, a family history of hypertension, a history of diabetes, and a history of hyperlipidemia. The most common complication of hypertension in middle-aged and elderly people in Anhui Province was cerebrovascular disease, followed by cardiovascular disease. Calcium channel blockers were the most commonly used antihypertensive drugs in middle-aged and elderly people in Anhui Province, followed by angiotensin converting enzyme inhibitor or angiotensin receptor blocker receptor antagonists.

Urban-rural differences in hypertension prevalence, blood pressure control, and systolic blood pressure levels.

Higher rates of cardiovascular events have been observed among rural residents compared with urban. Hypertension and lack of blood pressure (BP) control are risk factors for cardiovascular events. We compared the prevalence of hypertension and controlled BP, and the distribution of systolic blood pressure (SBP), by urban-rural residence. Participants from the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study, a prospective cohort of Black and White adults aged ≥45 years, were categorized as either urban, large rural, or small-isolated rural, by using the Rural-Urban Commuting Area (RUCA) categorization B system. Oucomes were hypertension prevalence (BP ≥ 140/90 mmHg or antihypertensive use), BP control (BP < 140/90 among participants on antihypertensive medication), and the distribution of SBP. Counfounders were age, race, sex, antihypertensive medication use, and US Census Bureau division. The analysis included 26,133 participants (80.3% urban, 11.6% large-rural, 8.2% small-isolated rural). The unadjusted prevalence of hypertension was not different between groups. However, after adjustment, the odds of hypertension was higher among participants in the large rural group (odds ratio [OR] 1.17; 95% confidence interval [CI], 1.08-1.27) and small-isolated rural group (OR 1.19; 95% CI, 1.08-1.30), compared with the urban group. There was no evidence of an adjusted difference in BP control for those taking antihypertensive medications. Adjusted differences in SBP were greater for both rural groups, compared with urban, at the higher percentiles of SBP. Rural residence was associated with a higher adjusted odds of hypertension and higher SBP.

GLOBAL PREVALENCE OF HYPERTENSION AMONG ART-NAÏVE ADULTS LIVING WITH HIV: A SYSTEMATIC REVIEW AND META-ANALYSIS

Objective: Cardiometabolic diseases have been suggested to be more frequent in people living with HIV (PLWH), resulting from the chronic inflammatory effects of the virus, effects of antiretroviral therapy (ART) and other factors that operate in the general population. Most studies have focused on assessing the prevalence of hypertension in PLWH on ART. Therefore, this study aimed to estimate the global prevalence of hypertension in the ART-naïve PLWH and to compare the prevalence among ART-naïve, ART-treated and HIV-negative subgroups. PROSPERO Registration: CRD42021226001. Design and method: We searched PubMed-MEDLINE, CINAHL, SCOPUS, Academic-Search Premier, Africa-Wide Information and Africa-Journals Online databases to identify relevant studies published before September 2022. We included Cross-sectional, cohort and case-control studies reporting baseline data on the prevalence of hypertension among ART-naïve adults living with HIV, worldwide. Two authors independently screened, selected, extracted data, and conducted methodological quality assessments. Data reported were pooled using random-effects meta-analysis. Results: Eighty studies across five continents comprising 204,876 ART-naive PLWH with mean/median ages ranging from 32 – 50 years were included. Most studies were from Africa; 43 (54%). The pooled prevalence of hypertension was 13.6% (95%CI: 10.5 - 17.0) among 39 studies that used a standard definition of hypertension (The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: JNC 7). The prevalence was 13.8% (95%CI: 10.4 - 17.5) based on a blood pressure cut-off of 140/90 mmHg only. There was no significant difference in hypertension prevalence by region, age, CD4 count, viral load, and publication year. Among the 9 studies that reported the prevalence by ART and HIV status, it was 9.6% (95%CI: 5.3 – 14.8), 17.7% (95%CI: 9.6 – 27.4) and 19.3% (95%CI: 10.1 – 30.5) in the ART-naïve, ART-treated and HIV negative subgroups respectively (p = 0.044). There was substantial heterogeneity (all I2 &gt;90%, and all p&lt;0.0001). There was no evidence of publication bias (all Egger test p &gt;0.1286). Conclusions: The prevalence of hypertension in ART-naïve adults living with HIV worldwide is lower than in ART-treated and HIV-negative adults and does not differ by age, CD4 count, viral load, publication year and region.

HYPERTENSION SUSCEPTIBILITY IN AFRICAN MIGRANTS: SOLVING THE PUZZLE THROUGH TRANSCONTINENTAL PROSPECTIVE COHORT STUDY DESIGN. THE RODAM-PROS STUDY

Objective: Sub-Saharan African (SSA) migrants are disproportionately affected by hypertension, compared to the European-host population. Underlying reasons for the increased hypertension prevalence are still unclear, but suggest that rapid changes in lifestyle and environment after migration, in combination with genetic factors, might be responsible. The aim of the Research on Obesity and Diabetes among African Migrant prospective (RODAM-Pros) cohort study is to identify key changes in environmental exposures and epigenetic modifications driving the high prevalence of hypertension among African migrants. Design and method: The multicentre RODAM-Pros study included non-migrant Ghanaians residing in rural and urban Ghana, Ghanaians who migrated and are residing in Amsterdam (the Netherlands), and European-Dutch population who participated in baseline (2011-2015) and follow-up data collection (2019-2021). Data were collected on anthropometrics, blood pressure, biological samples, sociodemographic, health, lifestyle and environmental factors. Moreover, ∼1300 participants were included for DNA methylation analysis (Infinium® 850K DNA Methylation BeadChip) to assess methylation loci associated with incident hypertension in a nested case-control study. Results: In the follow-up data collection, 2165 Ghanaian participants (n = 638 from rural Ghana, n = 608 from urban Ghana, and n = 919 Ghanaian migrants in Amsterdam) and 2098 European-Dutch participants were included. The participation rates were 90.8 % in rural Ghana, 95.3% in urban Ghana, 52.7% among Amsterdam-Ghanaian and 67.2% among European-Dutch. Preliminary results show unstandardised prevalence rates of hypertension at follow-up of 43.3% in rural Ghana, 48.7% in urban Ghana, 60.1% in Amsterdam-Ghanaians, and 25.8% in European-Dutch. Unstandardised 5-year hypertension incidence rates were 18.5% in rural Ghana, 17.7% in urban Ghana, 14.1% in Amsterdam-Ghanaians, and 8.5% in European-Dutch. Conclusions: The preliminary findings show significant differences in hypertension prevalence and incidence rates among Ghanaians living in Ghana and in Europe. Future analysis are aimed to identify epigenetic and environmental determinants responsible for the increased prevalence of hypertension in SSA migrants. The findings from the RODAM-Pros study will be valuable for designing effective prevention and clinical management strategies to prevent the burden of hypertension and related complications, both in SSA and SSA migrants in Europe.

The impact of updated clinical blood pressure guidelines on hypertension prevalence among children and adolescents.

To date, population estimates of hypertension prevalence among children and adolescents in Canada have been based on clinical guidelines in the National High Blood Pressure Education Program's 2004 Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents (NHBPEP 2004). In 2017, the American Academy of Pediatrics published updated guidelines in Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents (AAP 2017), followed by Hypertension Canada in 2020 with its publication of Comprehensive Guidelines for the Prevention, Diagnosis, Risk Assessment, and Treatment of Hypertension in Adults and Children (HC 2020). This study compares national child and adolescent hypertension prevalence estimates based on NHBPEP 2004, AAP 2017 and HC 2020. Six cycles of data spanning 2007 to 2019 from the Canadian Health Measures Survey were used to compare blood pressure (BP) categories and the prevalence of hypertension by sex and age group under all sets of guidelines for children and adolescents aged 6 to 17. The impact of applying AAP 2017 across time and selected characteristics, the resulting reclassification into a higher BP category under AAP 2017, and differences in hypertension prevalence resulting from applying HC 2020 versus AAP 2017 were examined. Prevalence of Stage 1 hypertension was higher among children and adolescents aged 6 to 17 under AAP 2017 and HC 2020 than under NHBPEP 2004. Overall hypertension prevalence was also higher, and obesity was a major factor associated with being reclassified into a higher BP category under AAP 2017. Implementation of AAP 2017 and HC 2020 is associated with significant changes in the epidemiology of hypertension. Understanding the impact of applying updated clinical guidelines may help inform population surveillance efforts to track hypertension prevalence among Canada's children and adolescents.

Cross sectional survey to assess the effectiveness of HT KOT among the Ayurveda medical practioners across India

Hypertension (High blood pressure) is ranked as the third most important risk factor for attributable burden of disease in south Asia. Hypertension (HTN) exerts a substantial public health burden on cardiovascular health status and healthcare systems in India. Overall prevalence for hypertension in India is 29.8% (95% confidence interval: 26.7–33.0). Significant differences in hypertension prevalence were noted between rural and urban parts of the population. [27.6% (23.2–32.0) and 33.8% (29.7–37.8); P = 0.05) It is estimated that at least one in four adults in India has hypertension, but, only about 12% of them have their blood pressure under control. India has set a target of 25% relative reduction in the prevalence of hypertension (raised blood pressure) by 2025. HT Kot tablet is used in the treatment and management of hypertension. HT Kot contain 3 ingredients namely Jadamamsi (Nardostachys jatamansi), Sarpagandha (Raufolia serpentine) and Ruraksha (Elaeocarpus sphaericus). It is observed that HT kot helps in improving the cardiovascular functions. It is also observed that HT Kot helps to reduce nervousness and anxiety. A descriptive cross sectional survey was done among Ayurvedic physicians in different parts of India. Out of 128 physicians, 86 (67.18%) physicians having more than 10 years of experiences. Survey reveals that majority of the physicians (more than 75%) opined that HT kot is effective in stage 1&amp;2 hypertension. The added effect of HT Kot is that it helps to improve the quality of sleep, reduce hyperactivity in children and anxiety. Majority of the respondents opined that the ideal time of administration of HT kot is after breakfast and dinner. The combination therapy with HT Kot is good in many conditions like hyperactivity, nervousness, hyperacidity and fatigue. The present article is based on the survey conducted among the Ayurvedic practioners in different parts of India, to assess the effectiveness and additional benefits observed with HT kot.

Higher blood pressure in adolescent boys after very preterm birth and fetal growth restriction

BackgroundAlthough preterm birth predisposes for cardiovascular disease, recent studies in children indicate normal blood pressure and arterial stiffness. This prospective cohort study therefore assessed blood pressure and arterial stiffness in adolescents born very preterm due to verified fetal growth restriction (FGR).MethodsAdolescents (14 (13–17) years; 52% girls) born very preterm with FGR (preterm FGR; n = 24) and two control groups born with appropriate birth weight (AGA), one in similar gestation (preterm AGA; n = 27) and one at term (term AGA; n = 28) were included. 24-hour ambulatory blood pressure and aortic pulse wave velocity (PWV) and distensibility by magnetic resonance imaging were acquired.ResultsThere were no group differences in prevalence of hypertension or in arterial stiffness (all p ≥ 0.1). In boys, diastolic and mean arterial blood pressures increased from term AGA to preterm AGA to preterm FGR with higher daytime and 24-hour mean arterial blood pressures in the preterm FGR as compared to the term AGA group. In girls, no group differences were observed (all p ≥ 0.1).ConclusionsVery preterm birth due to FGR is associated with higher, yet normal blood pressure in adolescent boys, suggesting an existing but limited impact of very preterm birth on cardiovascular risk in adolescence, enhanced by male sex and FGR.ImpactVery preterm birth due to fetal growth restriction was associated with higher, yet normal blood pressure in adolescent boys.In adolescence, very preterm birth due to fetal growth restriction was not associated with increased thoracic aortic stiffness.In adolescence, very preterm birth in itself showed an existing but limited effect on blood pressure and thoracic aortic stiffness.Male sex and fetal growth restriction enhanced the effect of preterm birth on blood pressure in adolescence.Male sex and fetal growth restriction should be considered as additional risk factors to that of preterm birth in cardiovascular risk stratification.

Urban-rural differences in hypertension prevalence in low-income and middle-income countries, 1990-2020: A systematic review and meta-analysis.

The influence of urbanicity on hypertension prevalence remains poorly understood. We conducted a systematic review and meta-analysis to assess the difference in hypertension prevalence between urban and rural areas in low-income and middle-income countries (LMICs), where the most pronounced urbanisation is underway. We searched PubMed, Web of Science, Scopus, and Embase, from 01/01/1990 to 10/03/2022. We included population-based studies with ≥400 participants 15 years and older, selected by using a valid sampling technique, from LMICs that reported the urban-rural difference in hypertension prevalence using similar blood pressure measurements. We excluded abstracts, reviews, non-English studies, and those with exclusively self-reported hypertension prevalence. Study selection, quality assessment, and data extraction were performed by 2 independent reviewers following a standardised protocol. Our primary outcome was the urban minus rural prevalence of hypertension. Hypertension was defined as systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure as ≥90 mm Hg and could include use of antihypertensive medication, self-reported diagnosis, or both. We investigated heterogeneity using study-level and socioeconomic country-level indicators. We conducted meta-analysis and meta-regression using random-effects models. This systematic review and meta-analysis has been registered with PROSPERO (CRD42018091671). We included 299 surveys from 66 LMICs, including 19,770,946 participants (mean age 45.4 ± SD = 9 years, 53.0% females and 63.1% from rural areas). The pooled prevalence of hypertension was 30.5% (95% CI, 28.9, 32.0) in urban areas and 27.9% (95% CI, 26.3, 29.6) in rural areas, resulting in a pooled urban-rural difference of 2.45% (95% CI, 1.57, 3.33, I-square: 99.71%, tau-square: 0.00524, Pheterogeneity < 0.001). Hypertension prevalence increased over time and the rate of change was greater in rural compared to urban areas, resulting in a pooled urban-rural difference of 5.75% (95% CI, 4.02, 7.48) in the period 1990 to 2004 and 1.38% (95% CI, 0.40, 2.37) in the period 2005 to 2020, p < 0.001 for time period. We observed substantial heterogeneity in the urban-rural difference of hypertension, which was partially explained by urban-rural definition, probably high risk of bias in sampling, country income status, region, and socioeconomic indicators. The urban-rural difference was 5.67% (95% CI, 4.22, 7.13) in low, 2.74% (95% CI, 1.41, 4.07) in lower-middle and -1.22% (95% CI, -2.73, 0.28) in upper-middle-income countries in the period 1990 to 2020, p < 0.001 for country income. The urban-rural difference was highest for South Asia (7.50%, 95% CI, 5.73, 9.26), followed by sub-Saharan Africa (4.24%, 95% CI, 2.62, 5.86) and reversed for Europe and Central Asia (-6.04%, 95% CI, -9.06, -3.01), in the period 1990 to 2020, p < 0.001 for region. Finally, the urban-rural difference in hypertension prevalence decreased nonlinearly with improvements in Human Development Index and infant mortality rate. Limitations included lack of data available from all LMICs and variability in urban and rural definitions in the literature. The prevalence of hypertension in LMICs increased between 1990 and 2020 in both urban and rural areas, but with a stronger trend in rural areas. The urban minus rural hypertension difference decreased with time, and with country-level socioeconomic development. Focused action, particularly in rural areas, is needed to tackle the burden of hypertension in LMICs.

Gender difference in prevalence of hypertension among Indians across various age-groups: a report from multiple nationally representative samples

BackgroundPrevalence of hypertension increases with age, but there is a general perception in India that women are less affected at every stage of life, although empiric evidence hardly exists regarding gender difference in hypertension in Indians of different ages. Therefore, we aimed to examine the gender difference in hypertension among Indians across various age-groups; and the contribution of variation in body mass index (BMI) to this difference.MethodsData were analysed after combining National Family Health Survey 4 (n = 294,584 aged 35–49 years) and Study of Ageing and Health wave 2 (n = 7118 aged 50 + years) datasets (NFHS-SAGE). Longitudinal Ageing Study of India (LASI) dataset (n = 65,900 aged > 45years) was analysed to replicate the results. Hypertension was defined if systolic and diastolic blood pressure was > 89 and/or > 139 respectively and/or if there was a history of anti-hypertensive medication. Descriptive summaries were tabulated and plotted to examine the gender difference in hypertension in various age-groups (35–39,40–44, 45–49, 50–54, 55–59, 60–64, 65–69, ≥ 70). Odds Ratios (ORs) from logistic regression models estimated the age gradient of hypertension and their male-female difference, adjusted for Body Mass Index (BMI).ResultsMales had a higher prevalence of hypertension up to 50 years; after that, females had higher rates. The estimates of age gradient, expressed as ORs, were 1.02 (1.02, 1.02) in males versus 1.05(1.05, 1.06) in females (p < 0.001) in NFHS-SAGE and 1.01(1.01, 1.02) in males versus 1.04(1.03, 1.04)in females (p < 0.001) in LASI;these differences marginally changed after adjustment with BMI.ConclusionThis is perhaps the first study to comprehensively demonstrate that cardio-metabolic risk in Indian females surpasses males after 50 years of age, “busting the myth” that Indian females are always at much lower risk than males; and this evidence should inform the Indian healthcare system to prioritise older women for screening and treatment of hypertension.

Sex Differences in Intracranial Atherosclerosis in Patients With Hypertension With Acute Ischemic Stroke.

BackgroundStudies suggest the presence of sex differences in hypertension prevalence and its associated outcomes in atherosclerosis and stroke. We hypothesized a higher intracranial atherosclerosis burden among men with hypertension and acute ischemic stroke compared with women.Methods and ResultsA multicenter retrospective study was performed from a prospective database identifying patients with hypertension presenting with intracranial atherosclerosis‐related acute ischemic stroke and imaged with intracranial vessel wall magnetic resonance imaging. Proximal and distal plaques on vessel wall magnetic resonance imaging were scored. Negative binomial models assessed the associations between plaque‐count and sex and the interaction between sex and treatment. Covariates were selected by a least absolute shrinkage and selection operator procedure. Sixty‐one patients (n=42 men) were included. There were no significant differences in demographic or cardiovascular risk factors except for smoking history (P=0.002). Adjusted total and proximal plaque counts for men were 1.6 (95% CI, 1.2–2.1; P<0.01) and 1.4 (95% CI, 1.0–1.9; P=0.03) times as high as women, respectively. Female sex was more protective for proximal plaque if treated for hypertension. The risk ratio of men versus women was 1.5 (95% CI, 1.0–2.1) for treated patients. The risk ratio of men versus women was 0.7 (95% CI, 0.4–1.3) for untreated patients. The relative difference between these 2 risk ratios was 2.0 (95% CI, 1.1–3.9), which was statistically significant from the interaction test, P=0.04.ConclusionsMen with hypertension with acute ischemic stroke have significantly higher total and proximal plaque burdens than women. Women with hypertension on anti‐hypertensive medication showed a greater reduction in proximal plaque burden than men. Further confirmation with a longitudinal cohort study is needed and may help evaluate whether different treatment guidelines for managing hypertension by sex can help reduce intracranial atherosclerosis burden and ultimately acute ischemic stroke risk.

Differences in Hypertension and Stage II Hypertension by Demographic and Risk Factors, Obtained by Two Different Protocols in US Adults: National Health and Nutrition Examination Survey, 2017-2018.

To compare prevalence of hypertension and stage II hypertension assessed by 2 blood pressure (BP) observation protocols. Participants aged 18 years and older (n = 4,689) in the National Health and Nutrition Examination Survey (NHANES 2017-2018) had their BP measured following 2 protocols: the legacy auscultation protocol (AP) and oscillometric protocol (OP). The order of protocols was randomly assigned. Prevalence estimates for hypertension (BP ≥130/80 mm Hg or use of medication for hypertension) and stage II hypertension (BP ≥140/90 mm Hg) were determined overall, by demographics, and by risk factors for each protocol. Ratios (OP% ÷ AP%) and kappa statistics were calculated. Age-adjusted hypertension prevalence was 44.5% (95% confidence interval [CI]: 41.1%-48.0%) using OP and 45.1% (95% CI: 41.5%-48.7%) using AP, prevalence ratio = 0.99 (95% CI = 0.94-1.04). Age-adjusted stage II hypertension prevalence was 15.8% (95% CI: 13.6%-18.2%) using AP and 17.1% (95% CI: 14.7%-19.7%) using OP, prevalence ratio = 0.92 (95% CI = 0.81-1.04). For both hypertension and stage II hypertension, the prevalence ratios by demographics and by risk factors all included unity in their 95% CI, except for stage II hypertension in adults 60+ years (ratio: 0.88 [95% CI: 0.78-0.98]). Kappa for agreement between protocols for hypertension and stage II hypertension was 0.75 (95% CI = 0.71-0.79) and 0.67 (95% CI = 0.61-0.72), respectively. In adults and for nearly all subcategories there were no significant differences in prevalence of hypertension and stage II hypertension between protocols, indicating that protocol change may not affect the national prevalence estimates of hypertension and stage II hypertension.

Urban-rural disparities in blood pressure and lifestyle risk factors of hypertension among Indian individuals.

This study aims to assess the urban-rural difference in prevalence of hypertension (HT) and to explore the disparities in lifestyle risk factors of HT among urban and rural individuals aged 15-49 years in India. The cross-sectional data collected as a part of the fourth round of National Family Health Survey (NFHS-4) was analysed in this observational study. NFHS-4 was conducted between January 2015 and December 2016 amongst men aged 15-54 years and women aged 15-49 years. In order to maintain uniformity, age group of 15-49 years was considered. Descriptive analyses were performed for sociodemographic and lifestyle factors. Binary logistic regression was conducted to assess the predictors of HT in men and women in urban and rural settings. The presence of HT was considered as the outcome variable. The overall age adjusted prevalence of HT was 17.2% and was greater in urban (18.3%) than in rural population (15.5%). The age adjusted prevalence was also higher in males (18.2%) as compared to females (16.1%). Age and wealth were associated with HT in both urban and rural population. Education and dietary habits played a role in all except rural men. Alcohol consumption, diabetic status and marital status were significantly associated with HT in both urban and rural women. Occupation was associated with HT only in urban women. The study has shown higher HT prevalence in urban areas despite higher prevalence of lifestyle risk factors in rural settings. This calls for more robust screening and health education in the entire population, especially in rural areas.

Prevalence of arterial hypertension among Ukrainian students: the comparison of European and American guidelines.

Arterial hypertension (HTN) among children is progressively increasing. These concerns have led to an update of the guidelines about childhood hypertension by the European Society of Hypertension (ESH) in 2016 and the American Academy of Pediatrics (AAP) in 2017, and their thresholds for HTN differ. The current research aims to compare the prevalence of hypertension in Ukrainian teenagers using 2 different guidelines and to check the impact of gender, age, and excess weight on hypertension. The sample includes 540 Ukrainian students of 2 secondary urban schools, aged 10-17 years. Blood pressure and anthropometrical measurements were taken and compared with percentile tables. The prevalence of abnormal BP (11.3% and 15.2%) and HTN (1.9% and 4.1%) was determined with ESH and AAP guidelines, respectively, and they strongly depended on which definitions and criteria were used. Boys were much more predisposed to abnormal BP. Comparing both guidelines, there was no significant difference in HTN prevalence in children aged 10-12 years; nevertheless, AAP recognized HTN almost twice as often in teenagers aged ≥ 13 years. Excess body weight was identified in 17.2% of the school-age children, twice as frequently as in males. The results have shown a higher prevalence of HTN in teenagers and children with excessive weight more significant in boys and between children with positive markers of abdominal obesity due to both guidelines, without a significant difference in prevalence after re-classification; however, AAP recommendations might be preferable.

Paediatric Hypertension in Africa: A Systematic Review and Meta-Analysis.

BackgroundThe burden of cardiovascular disease (CVD) and hypertension is rapidly increasing in low- and middle-income countries. This is evident not only in adults, but also in children. Recent estimates of prevalence in children are lacking, particularly in Africa. As such, we conducted a systematic review and meta-analysis to provide updated estimates of paediatric hypertension in Africa.MethodsWe searched PubMed and EBSCO to identify articles published from January 2017 to November 2020. Studies were assessed for quality. We combined results for meta-analyses using a random effects model (Freeman-Tukey arcsine transformation). Heterogeneity was quantified using the I2 statistic.FindingsIn the narrative synthesis of 53 studies, publication bias was low for 28, moderate for 24, and high for one study. Hypertension prevalence ranged substantially (0·2%-38·9%). Meta-analysis included 41 studies resulting in data on 52918 participants aged 3 to 19 years from ten countries. The pooled prevalence for hypertension (systolic/diastolic BP≥95th percentile) was 7·45% (95%CI 5·30-9·92, I2=98.96%), elevated blood pressure (BP, systolic/diastolic BP≥90th percentile and <95th percentile) 11·38% (95%CI 7·94-15·33, I2=98.97%) and combined hypertension/elevated BP 21·74% (95%CI 15·5-28·69, I2=99.48%). Participants categorized as overweight/with obesity had a higher prevalence of hypertension (18·5% [95%CI 10·2-28·5]) than those categorized as underweight/normal (1·0% [95%CI 0·1-2·6], 4·8% [95%CI 2·9-7·1], p<0·001). There were significant differences in hypertension prevalence when comparing BP measurement methods and classification guidelines.InterpretationCompared to a previous systematic review conducted in 2017, this study suggests a continued increase in prevalence of paediatric hypertension in Africa, and highlights the potential role of increasing overweight/obesity.FundingThis research was funded in part by the Wellcome Trust [Grant number:214082/Z/18/Z]. LJW and SAN are supported by the DSI-NRF Centre of Human Development at the University of the Witwatersrand.

Hypertension in women: the role of adolescent childbearing

BackgroundAdolescent childbearing is associated with various health risks to the mother and child, and potentially with adverse socioeconomic outcomes. However, little is known about the role of adolescent childbearing in maternal health outcomes in adulthood. This study investigates the link between childbirth in adolescence and later-life risk of hypertension among women in India.MethodsWe obtained nationally representative data on demographic and health outcomes for 442,845 women aged 25 to 49 from the India National Family Health Survey (NFHS) 2015-16. We assessed the difference in hypertension prevalence between women who gave birth in adolescence (age 10 to 19) and those who did not, for the full sample and various sub-samples, using linear probability models with controls for individual characteristics, hypertension risk factors, and geographic fixed effects.ResultsNearly 40% of the women in the sample gave birth in adolescence. The adjusted probability of being hypertensive in adulthood was 2.3 percentage points higher for this group compared to women who did not give childbirth in adolescence. This added probability was larger for women who gave birth earlier in adolescence (4.8 percentage points) and for women who gave birth more than once in adolescence (3.4 percentage points).ConclusionsAdolescent childbearing was strongly associated with a higher probability of adult female hypertension in India. This finding illustrates the intertemporal relationship between health risk factors during the life cycle, informing the importance of addressing adverse early life events (e.g. child marriage and adolescent childbirth) for hypertension outcomes among women in India.

1063-P: Regional Variation in Hypertension Prevalence among Older Adults with and without Diabetes, 2005-2017

In the US, hypertension prevalence among adults has been stable since 2000. Whether these trends vary for older adults across geographic regions is unknown. This study used the 5% sample of Medicare administrative claims data (2005-2017) to examine trends in hypertension prevalence among older adults with and without diabetes by U.S. Census region (Midwest, Northeast, South, West). Participants aged ≥66 years with 12 months of continuous coverage of Part A and Part B were included. Hypertension and diabetes were assessed using ICD-9/ICD-10 codes from inpatient or outpatient claims in the index year. Joinpoint regression was used to estimate the annual percentage change in age-standardized hypertension prevalence by region. Overall, hypertension prevalence increased among older adults with and without diabetes across regions (Figure 1). Among older adults with diabetes, the average annual percentage change was lowest in the West (0.27) and highest in the South (0.45) from 2011 to 2017. Among those without diabetes, hypertension prevalence declined in the West (-0.2) and increased in the South (0.6) from 2009 to 2017. Regional differences in hypertension prevalence were present among older adults and highlight the importance of identifying and understanding the causes of disease burden across geographies and time. Disclosure J. Uddin: None. S. Zhu: None. G. Malla: None. E. B. Levitan: Research Support; Self; Amgen Inc. D. B. Rolka: None. D. Long: None. A. P. Carson: Research Support; Self; Amgen Inc. Funding Centers for Disease Control and Prevention (U01DP006302)

Differences in Hypertension Prevalence and Hypertension Control by Urbanization Among Adults in the United States, 2013-2018.

To examine the associations between urbanization and hypertension, stage II hypertension, and hypertension control. Data on 16,360 US adults aged 18 years or older from the 2013-2018 National Health and Nutrition Examination Survey (NHANES) were used to estimate the prevalence of hypertension (blood pressure (BP) ≥130/80 mm Hg or use of medication for hypertension), stage II hypertension (BP ≥140/90 mm Hg), and hypertension control (BP <130/80 mm Hg among hypertensives) by urbanization, classified by levels of metropolitan statistical areas as large MSAs (population ≥1,000,000), medium to small MSAs (population 50,000-999,999), and non-MSAs (population <50,000). All prevalence ratios (PRs) were compared with large MSAs and adjusted for demographics and risk factors. The PRs of hypertension were 1.07 (95% confidence interval (CI) = 0.99-1.14) for adults residing in medium to small MSAs and 1.06 (95% CI = 0.99-1.13) for adults residing in non-MSAs. For stage II hypertension, the PRs were higher for adults residing in medium to small MSAs 1.21 (95% CI = 1.06-1.36) but not for adults residing in non-MSAs 1.06 (95% CI = 0.88-1.29). For hypertension control, the PRs were 0.96 (95% CI = 0.91-1.01) for adults residing in medium to small MSAs and 1.00 (95% CI = 0.93-1.06) for adults residing in non-MSAs. Among US adults, urbanization was associated with stage II hypertension.