Prevalence Of Hypertension Research Articles

Comment on: “Exploring the impact of short sleep on hypertension prevalence in the Chinese population: dose-response relationships, standardisation, and health behaviours”

Newly detected atrial fibrillation after stroke (AFDAS) is a specific type of AF and have a different pathophysiology compared to patients with previously known AF before a stroke (KAF). However, the characteristics and outcomes between AFDAS and KAF have not been well studied. We aimed to further explore the clinical characteristics and long-term functional outcomes between AFDAS and KAF. We retrospectively analyzed acute ischemic stroke patients admitted to our hospital between 2010 and 2017, who was also diagnosed with AF. The poor outcome was defined by the combination of death and any disability as scored by the modified Rankin Scale (mRS) score at 3 months and 12 months. Among the final sample of 698 patients, 370 (53%) were classified into KAF and 328 (47%) were AFDAS. Compared to KAF, patients with AFDAS had a lower prevalence of hypertension (P = 0.01), previous stroke (P = 0.02), higher prevalence of valvular heart disease (P = 0.02), less prescribed with anticoagulants during the hospitalization (P < 0.01), and higher mortality at 3 months (OR 1.77, 95%CI 1.07-2.92, P = 0.03). Patients with AFDAS had an increased trend of mRS score compared to KAF (3 months, OR 1.37, 95% CI 1.04-1.81, P = 0.02; 12 months, OR 1.32, 95%CI 1.01-1.75, P = 0.04). Patients with AFDAS had a higher risk of death and an increased trend of mRS score compared to KAF. Lower utilization of anticoagulation may be a major reason of worse outcome in AFDAS. Further investigation is required to identify whether the differences of the outcomes between AFDAS and KAF is confounded by pre-existing anticoagulation.

Hypertension is one of the most prevalent non-communicable diseases in modern society. Despite the issue having existed for years, no long-term interventions have been proven to completely curb it. This scoping review aims at examining the risk factors that influence the high prevalence of hypertension in low- and middle-income countries (LMICs). A systematic approach to literature collection is employed through a broad search strategy. The search utilised the following databases: PubMed, Google Scholar, DoPHER and TRoPHI. These databases were chosen because they provide the largest health science article collections, especially in public health, medicine and intervention research in LMICs. The initial search yielded 1 267 articles. However, through rigorous analysis and application of the exclusion criteria, only 30 articles were found to meet the inclusion criteria and thus used for the research analysis. The data analysis used the Arksey and O’Malley’s (2005) framework. The results indicate that most people in LMICs have limited resources to enable quality and affordable access to health facilities. The government and relevant health departments have not invested significantly in ensuring the availability of health facilities and amenities. Another factor identified are lifestyle factors, as people in these countries have a high intake of unhealthy processed and fast foods. Most of the population is always trying to gain enough income to meet their basic needs and thus lack enough time to engage in physical exercise. However, the prevalence is also affected by regional levels, rationalising the need for specific interventions to address the prevailing issues. The research concludes with a recommendation for developing significant interventions and more regionally specific research, as root causes differ from country to country. There is also need to have more specific research that seeks to identify the relationship between cultural practices and hypertension prevalence.

Aortic dissection and aneurysm are deadly complications of hypertension and remain important causes of cardiovascular mortality. Due to the rise in prevalence of hypertension in the United States, it is critically important that we analyze mortality trends for vascular emergencies. Using national data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research, we analyzed mortality from the age of 25 up through 85 years and older from the period between 1999 and 2020. Crude mortality rates, age-adjusted mortality rates, and yearly percent change and the corresponding 95% confidence intervals were estimated. From 113,728 reported deaths due to aortic dissection and aneurysm and hypertension during the study interval, mortality trends indicated a mortality rate initially decreasing from 2.42 in 2001 to 2.27 in 2015, and subsequently increasing to 2.67 in 2015-2020, representing a total rise from 1.64 in 1999 to a level of 2.67 in 2020. Mortality was higher among males than females throughout the period, at levels of 3.87 and 1.77 per 100,000 in 2020. Disparities by race and ethnicity also emerged, as non-Hispanic Black race showed the maximum mortality, followed by non-Hispanic Asian and non-Hispanic White, and much lower among Hispanics and in non-Hispanic American Indian. Geographic variations also became apparent, as evidenced by the West reporting the maximum mortality burden. These findings indicate that after reductions observed in the past, mortality from aortic dissection and aneurysm related to hypertension has increased in recent years, emphasizing the importance of targeted prevention interventions.

Background Hypertension is a common comorbidity in type 2 diabetes mellitus (T2DM) and increases cardiovascular risk. Hepatic steatosis, a hallmark of metabolic dysfunction frequently observed in T2DM, may contribute to elevated blood pressure. The hepatic steatosis index (HSI) is a simple, non-invasive marker of liver fat, but its predictive value for hypertension in T2DM patients remains unclear. Methods This cross-sectional study retrospectively included 1,744 hospitalized T2DM patients at Linyi People’s Hospital from 2020 to 2023. Demographic, anthropometric, and laboratory data were collected, and HSI was calculated. Patients were classified as hypertensive ( n = 604) or non-hypertensive ( n = 1,140) and further stratified by HSI quartiles (Q1–Q4). Univariate and multivariate logistic regression analyses were performed to assess the association between HSI and hypertension. Results Patients with hypertension had significantly higher HSI levels than those without ( p &amp;lt; 0.05). Hypertension prevalence increased progressively across HSI quartiles, with the highest in Q4 ( p &amp;lt; 0.01). In multivariate analysis, after adjustment for potential confounders, HSI remained independently associated with hypertension (OR = 1.054; 95% CI: 1.025–1.085; p &amp;lt; 0.001). Conclusion HSI is independently associated with hypertension in T2DM and may serve as a practical tool for risk stratification. These findings underscore the link between hepatic steatosis and cardiovascular risk, and further studies are warranted to confirm causality and clinical utility.

Abstract Sustainable Development Goal 7 aims to ensure access to clean and affordable energy for all. India has implemented large-scale policies to improve access to clean fuels (CFs) such as liquefied petroleum gas. However, the impacts of such policies on public health outcomes have been understudied. This study utilized data from India’s National Family Health Surveys (NFHSs) conducted in 2016 and 2021 to evaluate the associations between changes in the prevalence of non-CF (non-CF) usage, driven by India’s clean energy policies, and hypertension, a significant cardiovascular disease risk factor, on a national level. Specifically, a precision-weighted method that accounts for survey design and sampling variability was implemented to estimate the prevalence of hypertension and a wide range of socio-economic (SES) factors for the years 2010–2015 (NFHS-4) and 2015–2020 (NFHS-5) at the district level for the 2019/20 NFHS-5. Associations between the change in solid-fuel use, also termed as non-CF at the district level between 2015–2020 and 2010–2015, and the change in the prevalence of hypertension after controlling for various SES were investigated using regression analyzes. A significant decrease in hypertension prevalence: 0.41% (95% CI: 0.07%, 0.75%) was associated with a 10% point decrease in the prevalence of non-CF use at the district level. Subpopulation-specific analyzes revealed substantial variation in associations by gender, region, urban/rural designation, socioeconomic groups, and age. Specifically, these associations were highest among older populations and residents of North India.

Evaluating the Association of Occupational Noise Exposure with Hypertension Prevalence in Public Transport Bus Drivers

Background. Hypertension is a leading cause of cardiovascular disease. There are limited longitudinal data on temporal trends in hypertension prevalence in rural South Africa (SA). Objectives. To analyse trends in hypertension prevalence and investigate its associated factors among adults aged ≥40 years in SA. Methods. A retrospective observational secondary quantitative analysis of a sample from the Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) was conducted. Data for the HAALSI study were collected over three waves during 2014, 2018 and 2021 from the existing Agincourt Health and Socio-demographic Surveillance System (AHDSS) framework, with a total sample of 3 707 participants in the present study. Descriptive statistics were used to summarise sociodemographic data. A bivariate analysis and multivariable generalised estimating equation (GEE) model was applied to determine factors associated with hypertension prevalence, with significance set at p&lt;0.05. Results. The overall prevalence of hypertension declined from 58% (95% confidence interval (CI) 56.42 - 59.58) in wave 1 to 42% (95% CI 40.42 - 43.58) in wave 2, and further decreased to 30% (95% CI 28.58 - 31.42) in wave 3. Transitions between hypertensive and normotensive status were observed, with 1 018 individuals transitioning to normotensive from wave 1 to wave 2, and 1 167 individuals from wave 2 to wave 3. The GEE analysis identified significant predictors of hypertension. High body mass index (BMI) was associated with increased odds in wave 2 (adjusted odds ratio (aOR) 1.11; 95% CI 1.02 - 1.21; p=0.014). Frequent alcohol consumption increased the odds of hypertension in wave 3 (aOR 1.19; 95% CI 1.04 - 1.37; p=0.009). No formal education was associated with higher hypertension prevalence (aOR 1.07; 95% CI:1.00 - 1.14; p=0.0026). Younger age (40 - 49 years) was protective, with decreased odds of hypertension in wave 2 (aOR 0.64; 95% CI 0.48 - 0.84; p=0.014), as was employment (aOR 0.82; 95% CI 0.69 - 0.96; p=0.020) and fruit consumption in wave 3 (aOR 0.95; 95% CI 0.91 - 0.99; p=0.037). Conclusion. The study found that the prevalence of hypertension in Agincourt decreased from 58 to 30% between waves 1 and 3. High BMI, high alcohol use frequency and no formal education were key predators of hypertension. The study highlights the need for targeted public health interventions, including regular hypertension screening, lifestyle modification and better management of associated factors. These efforts will be crucial in reducing hypertension-related morbidity and mortality in rural SA.

Background: Hypertension disproportionately affects marginalized populations, including women experiencing homelessness (WEH), who face barriers to healthcare and chronic disease management. Limited access to healthcare services places WEH at an increased risk for undiagnosed and uncontrolled hypertension. This study examines disparities in blood pressure levels, hypertension prevalence, and pulse pressure (PP) between WEH and age-matched women from the general population. Methods: This cross-sectional study compared blood pressure (BP) patterns between WEH attending a student-run free clinic (SRFC) in Miami, FL, and age-matched women from the 2021–2023 NHANES dataset. Hypertension was defined per AHA guidelines (SBP ≥130 mmHg or DBP ≥80 mmHg). Descriptive statistics summarized baseline characteristics. Wilcoxon rank-sum tests compared SBP, DBP, and Pulse Pressure (PP) between groups. Chi-square and Fisher’s Exact tests assessed the association between group and hypertension prevalence. Effect sizes were calculated using Cramer’s V and the Phi coefficient, with statistical significance set at p &lt; 0.05. Results: Among 110 participants (55 per group), hypertension prevalence was significantly higher in the WEH group (60% vs. 34.6%, p = 0.0075). Diastolic BP was significantly elevated in WEH (p &lt; 0.0001), while systolic BP was not (p = 0.0812). Pulse pressure (PP) was lower in WEH (46.2 vs. 54.8 mmHg, p = 0.0035). Conclusion: WEH showed a distinct hypertension profile with elevated DBP and lower PP, suggesting stress- or volume-driven mechanisms. These findings highlight the need for targeted hypertension interventions in SRFCs, including stress reduction programs, volume control education, and longitudinal BP monitoring to improve cardiovascular health in this underserved population.

Background: Hypertension-related cardiovascular disease (CVD) mortality in women has increased by 2.2% annually in recent years, while national hypertension control rates among women remain stagnant at 23.1%. Despite this trend, no prior study has quantified preventable CVD deaths among U.S. women by race/ethnicity and age using linked national datasets. Research Question: What is the extent of preventable cardiovascular mortality due to uncontrolled hypertension among U.S. women, and how do disparities in hypertension control rates by race/ethnicity, age, and geographic location contribute to this burden between 2017 and 2022? Methods: We analyzed approximately 60,000 female CVD deaths with hypertension listed as a contributing cause (ICD-10 I10–I15) from CDC WONDER between 2017 and 2022. Hypertension prevalence and control rates (&lt;130/80 mmHg) were assessed using data from approximately 3,000 women in NHANES 2017–2020. Geographic disparities in hypertension control were evaluated using CDC PLACES data. Population-attributable fractions were calculated to estimate the contribution of uncontrolled hypertension to CVD mortality. Adjusted odds ratios for mortality risk were derived using multivariable logistic regression models that accounted for age, race/ethnicity, and comorbidities. Regional mortality patterns were mapped against control rate disparities. Results: Among U.S. women, hypertension prevalence was 44.8%, with 23.1% controlled. Age-adjusted CVD mortality was 31.2 per 100,000. Uncontrolled hypertension raised CVD mortality risk (OR 2.4; 95% CI: 2.0–2.9). Black women had 56.7% prevalence, 19.8% control, a 45.3 per 100,000 mortality rate (OR 2.7; 95% CI: 2.3–3.2). Rural women showed 47.2% prevalence, 21.3% control, and 35.6 per 100,000 mortality (OR 2.6; 95% CI: 2.1–3.1), lower than urban control rates (25.7%, p&lt;0.01). Women aged 65+ had 68.3% prevalence, 18.9% control, and 110.5 per 100,000 mortality (OR 3.0; 95% CI: 2.6–3.5). Uncontrolled hypertension caused 12,400 annual CVD deaths, highlighting disparities in older, Black, and rural women. Conclusions: Uncontrolled hypertension is responsible for a substantial proportion of preventable cardiovascular deaths among U.S. women. The burden is especially pronounced among Black women, those living in rural areas, and older adults. Interventions aimed at closing the gender gap in hypertension control are urgently needed to address this preventable mortality crisis.

Background: Despite declines in environmental lead exposure, it remains a significant public health issue, particularly for children and adolescents in low-income and minority communities. While the neurodevelopmental harms of lead are well documented, emerging evidence suggests that early-life exposure may also increase cardiometabolic risk during adolescence. Even low-level exposure, below current intervention thresholds, has been linked to adverse outcomes, underscoring the continued need for vigilance and prevention. Objective: To examine associations between blood lead levels (BLL) and the prevalence of diabetes, hyperlipidemia, and hypertension in U.S. adolescents, and to explore how sex and insurance status modify these associations using data from the Environmental Influences on Child Health Outcomes (ECHO) National Cohort. Methods: We analyzed cross-sectional data from 628 adolescents (mean age = 12.35 years, SD = 3.88). The sample was 53.5% female and 22.9% identified as Hispanic/Latino. The mean BLL was 1.38 µg/dL (SD = 6.09). Prevalence of diabetes, hyperlipidemia, and hypertension was 32.8%, 33.6%, and 33.1%, respectively. Insurance/employment status was operationalized as Medicare coverage (vs. not). Logistic regression models were fit for each cardiometabolic outcome, adjusting for race, ethnicity, sex, and Medicare status. Results: Higher BLL was significantly associated with greater odds of diabetes (OR = 1.29, p = 0.007), with a stronger trend among males than females (p = 0.051 for sex). For hyperlipidemia, BLL was also a significant predictor (OR = 1.20, p = 0.028). Importantly, adolescents covered by Medicare had significantly higher odds of hyperlipidemia (OR = 2.06, p = 0.001), suggesting a link between socioeconomic vulnerability and lipid risk. BLL was not significantly associated with hypertension (OR = 1.11, p = 0.16), though Medicare coverage remained marginally significant in that model (p = 0.049). Race and ethnicity were not significant covariates across models. Conclusion: In this national sample of adolescents, elevated blood lead levels were associated with increased risk of diabetes and hyperlipidemia, with indications of sex-based differences in diabetes risk and a pronounced role for Medicare coverage in hyperlipidemia outcomes. These findings suggest that both environmental and socioeconomic factors contribute to early cardiometabolic vulnerability and should be central to prevention efforts targeting youth health equity.

Introduction: Cardiometabolic risk factors remain the leading cause of cardiovascular disease (CVD) and death in the US. US women veterans (WV) are a growing, high-risk population with higher rates of chronic conditions and increasing engagement with veteran affair (VA) healthcare yet remain understudied. Objectives: This study aimed to investigate the potential ethnic/racial and age group differences in the life-long prevalence of traditional cardiometabolic risk factors among US WV from 2000-2019. Methods: The national VA electronic health records (her) were used to assess the prevalence of diabetes, hypertension, hyperlipidemia, smoking, and neuroendocrine disorders among US WV who visited a VA facility from 1/1/2000 to 12/31/2019. Diagnoses were based on international classification of disease (ICD)-9 and -10 codes. Participants were stratified by races/ethnicities (non-Hispanic White, Black, Asian, American Indian/Pacific Islander, and Hispanic/Latino) and age group (18-39, 40-59, 60+). Age-standardized lifelong prevalence of CVD risk factors was assessed overall, by races/ethnicities, and by age groups. Age-standardized lifelong prevalence represents the sum of raw age-specific risk factor rates multiplying the standard age-specific proportion in the 2000 U.S. census reference population Results: The WV cohort expanded from 80,707 in 2000 to 739,309 in 2019. Significant racial/ethnic disparities emerged. Blacks demonstrated the highest prevalence of diabetes (from 13.5% to 19.2%) and hypertension (38.2% to 43.9%). Notably, American Islanders showed the most rapid escalation in diabetes (1.9-fold increase). Whites maintained the highest prevalence of smoking, hyperlipidemia, and neuroendocrine disorders. Asians experienced a 9.6-fold surge in smoking (3.8% to 36.5%), while Black saw a 3.1-fold rise in hyperlipidemia (11.5% to 35.8%) and a 3.1-fold rise in neuroendocrine disorders. The remaining subgroups exhibited absolute prevalence increases of approximately 40% for smoking and 20% for hyperlipidemia. Marked age-related patterns also emerged. The 60+ age group had the highest prevalence of risk factors from 2000-2019, except smoking. This group also exhibited the greatest fold increases in every category except hypertension. Conclusion: The cardiometabolic risk burden among U.S. women veterans has reached critical levels, with pronounced racial/ethnic and age group disparities, necessitating immediate targeted public health interventions.

Introduction: There has been a steady rise in the prevalence of hypertension in adults with congenital heart disease (ACHD) and is now comparable to the general population. The burden and impact of acute presentation with hypertensive crisis (HC) remains unclear in the ACHD population warranting further investigation. Research Question: To investigate the prevalence of hypertensive crisis amongst hospitalizations in the ACHD population and its related trends and outcomes. Methods: We utilized the National Inpatient Sample to identify adults ≥18 years between 2016 and 2022 with underlying congenital heart disease admitted with HC, including hypertensive urgency, hypertensive emergency and unspecified HC. ACHD patients were grouped into mild and moderate/great complexity heart disease for sub-group analysis. Trend analysis was performed. We performed a 2:1 propensity matching to control for relevant demographic and clinical variables when comparing outcomes with non-ACHD patients presenting with HC. Results: A total of 6,280 hospitalizations were identified for hypertensive crisis amongst ACHD patients, representing 1.1% of all hospitalizations amongst ACHD patients. The mean patient age was 57.9 years and 49.9% were female. Most prevalent comorbidities included coronary artery disease (53.6%), congestive heart failure (43.5%) and diabetes mellitus (36.1%). The hospitalization rate for HC in ACHD patients has been on a gradual rise, increasing from 0.76% of all hospitalizations in 2017 to 1.2% in 2022 (p trend 0.06). After propensity matching, ACHD patients had higher rates of STEMI compared to non-ACHD patients presenting with HC (3.9% vs 2.2%, p &lt; 0.05). Additionally, ACHD patients also had a longer hospital stay (6.8 days vs 5.6 days, p &lt; 0.05). The outcomes for mortality, stroke, and acute heart failure, were similar. In the subgroup analysis, patients with simple congenital heart disease had lower mortality compared to non-ACHD patients (0.98% vs 2.4%, p = 0.03). Conclusion(s): The overall prevalence of hypertensive crisis amongst hospitalizations in ACHD patients is low at 1% though demonstrating a gradual increase over the years. Patients with ACHD demonstrate worse STEMI and resource utilization outcomes including length of hospital stay. The higher occurrence of STEMI in ACHD patients emphasizes the growing need to investigate disease patterns and management of acquired heart diseases that may otherwise get overlooked in this unique subset of patients.

Introduction: Obesity is one of the main causes of heart failure (HF) and atrial fibrillation (AF), respectively. Sarcopenic obesity is prevalent in patients with HF and is associated with poor clinical outcomes. Creatine kinase (CK) is an enzyme that provides ATP for contraction in muscle, and serum CK is readily available in daily clinical practice and is reported to reflect amount of muscle and physical activity. However, little is known about the association of serum CK with HF in obese patients with AF. Methods: The Fushimi AF Registry, a community-based prospective survey, was designed to enroll all of the AF patients in an urban community in Japan. Follow-up data were available for 4,496 patients as of February 2022, and the median follow-up period was 2,096 days. Of them, we excluded 1,407 without serum CK data at baseline. We divided 789 obese patients (criteria for Japanese people; BMI 25 kg/m 2 or above) into two groups according to serum CK level (low CK:&lt;59 IU/l in male, &lt;41 in female; n=116,non-low CK; n=673), and compared the baseline clinical characteristics and incidence of hospitalization for HF. Results: Low CK group was older (low CK vs. non-low CK; 74.7±10.3 vs. 70.8±10.7 years; p&lt;0.01), had more prevalence of diabetes (44.8 vs.32.1 %; p&lt;0.01) and anemia (19.0 vs.8.8 %; p&lt;0.01) and higher CHA 2 DS 2 -VASc score (3.85±1.62 vs. 3.31±1.64; p&lt;0.01) than non-low CK groups. Sex, BMI, systolic blood pressure, pulse rate, paroxysmal AF, prevalence of hypertension, chronic kidney disease and organic heart disease, the prescription of oral diuretics, prior catheter ablation, brain natriuretic peptide level, left ventricular ejection fraction and left atrial diameter were comparable between the groups. During the median follow-up period of 2,542 days, 150 hospitalizations for HF occurred. In Kaplan-Meier analysis, the incidence of HF was higher in low CK group (5.72 vs. 2.95 per 100 person-years; p=0.001, by log-rank test) (Figure). Low CK (hazard ratio [95% confidential interval]: 2.20 [1.22–3.96]; p&lt;0.01) was an independent predictor of the incidence of hospitalization for HF after adjustment by age, left atrial diameter, brain natriuretic peptide level and the components of H 2 ARDD score (Am J Cardiol 2012;110:678-682.) (Table). Conclusions: Low CK was independently associated with incidence of hospitalization for HF among Japanese obese patients with AF.

Background: Sex differences in the burden and management of cardiovascular disease (CVD) risk factors persist despite widespread prevention guidelines. Our study examines sex differences in the prevalence, treatment, and control of hypertension (HTN) using real-world, electronic health patient data from a large integrated health system. Methods: We conducted a retrospective cohort study using 2024 Northwell Health Allscripts TouchWorks electronic health record (EHR) system data. Adult patients (N = 268,167) with available EHR blood pressure (BP) measurements were included. We assessed stage of hypertension prevalence based on blood pressure levels; elevated BP defined as systolic BP 120-129 mmHg and diastolic BP &lt;80 mmHg, Stage 1 HTN defined as systolic BP between 130-139 mmHg and/or diastolic BP between 80-89 mmHg and Stage 2 HTN defined as defined as systolic BP 140 mmHg and/or higher or diastolic BP 90 mmHg or higher. Hypertension was defined based on diagnosis codes, antihypertensive medication use, and/or measured systolic BP ≥130 mmHg or diastolic BP ≥80 mmHg. For patients who were taking anti-hypertensive medications, we defined HTN control as systolic BP &lt; 130 and diastolic BP &lt; 80 mmHg. We employed age-adjusted linear and logistic regression models to assess sex differences with HTN prevalence, treatment and control. Results: Overall, men had higher mean systolic (125.1 vs. 122.2 mmHg) and diastolic (75.5 vs. 74.9 mmHg) pressures than women (p &lt; 0.05). Men had a higher prevalence of elevated BP, Stage 1 HTN and Stage 2 HTN compared with women (12.9 vs. 11.8%, 32.5 vs. 31.1% and 16.9 vs. 14.0%, respectively, p value &lt; 0.05). Compared with women, men had a significantly higher prevalence of diagnosed HTN and a greater prevalence of anti-hypertensive use (figure). When treated with anti-hypertensive therapy, women were significantly less likely to have control of BP compared with men (figure). Conclusions: Rates of HTN control in our cohort were relatively low overall. Despite a lower burden of diagnosed HTN, women in our large and diverse health system were less likely to experience HTN control than men. Our findings underscore the need for targeted, sex-specific approaches to improve cardiovascular risk factor management in clinical care.

Introduction/Background: People with HIV (PWH) in high-income countries experience an increased risk of ischemic heart disease and arrythmia. Little is known, though, about the relative frequency of electrocardiogram (ECG) abnormalities in PWH on modern ART in Africa. Research Questions: What is the prevalence of standard ECG findings in a typical East African population of PWH compared to HIV-uninfected community controls and test characteristics of ECG criteria for left ventricular hypertrophy (LVH)? Methods: We conducted a cross-sectional analysis of baseline ECG data from an ongoing prospective cohort of PWH and HIV-uninfected community controls enrolled from three public HIV clinics in Tanzania (the Mwanza HIV&amp;CVD Cohort). ECGs were coded by a cardiologist blinded to the patient’s clinical characteristics. LVH ECG criteria were compared to evidence of LVH on transthoracic echocardiogram (TTE). The prevalence of ECG findings in PWH and HIV-uninfected were compared using a chi-square test. Results: Of 1000 participants enrolled between March 2022 and May 2023, 999 had ECG completed (500 PWH and 499 HIV-uninfected). The median age was 44 years [IQR 38-50] and 69.8% were female. Among PWH, all participants had been on a combination of tenofovir, lamivudine, and dolutegravir for at least 3 months and 98% were virologically suppressed. The prevalence of hypertension according to office blood pressure was 13.4%. Sinus bradycardia was common in this population and more so in PWH (37.2%) vs. community controls (30.7%, p = 0.029) (Table 1). Atrial premature contractions were more common in HIV-uninfected (5.2% vs 1.2% in PWH, p = 0.048) while changes of anterior ischemia were more common in PLH (2.8% vs 0.8% in community controls, p = 0.018). ECG criteria for LVH had low sensitivity but high specificity when compared to TTE (for any level of LVH, sensitivity by specific ECG criteria ranged from 0 to 19.6% with specificity ranging from 89.7% to 99.6%) (Table 2). Conclusion: Sinus bradycardia, 1 st degree AV block, LVH, and atrial premature contractions were the most common ECG abnormalities observed in this East African population. PWH had more sinus bradycardia and anterior ischemia but less atrial premature contractions. ECG criteria for LVH had low sensitivity but high specificity. These findings will inform the clinical care of similar patients in the future, as baseline prevalence of these findings in East African populations is unknown.

Background: Hypertension (HTN) is a key driver of cardiovascular disease (CVD). Racial and ethnic disparities in HTN have been noted, yet the contributions of socioeconomic, lifestyle, and psychosocial factors underlying disparities remain understudied. We examined the associations between race/ethnicity and HTN outcomes, accounting for these factors. Methods: We analyzed 5,492 participants in the Multi-Ethnic Study of Atherosclerosis (MESA), a prospective cohort of adults aged 45-84 years free of clinical CVD at baseline. Outcomes included baseline prevalent HTN (BP≥140/90 mmHg and/or BP medication use), HTN treatment and control, and incident HTN over ~16 years. Multivariable regression models were used to estimate associations between race/ethnicity and each outcome using sequential modeling, adjusting for age, sex, education, income, insurance, neighborhood SES, BMI, exercise, diet, smoking, alcohol, social support, discrimination, and chronic stress. Results: (See figure) At baseline, 47% had HTN. Prevalence was highest among Black followed by Hispanic, White, and Chinese participants. Adjustment for socioeconomic, lifestyle, and psychosocial factors reduced the prevalence ratio for Black compared to White participants, but remained significantly elevated. Chinese participants had lower HTN odds in partially adjusted models, but this association was not significant after full adjustment. Among those with HTN, all non-White groups had higher odds of being in the “treated but uncontrolled” category compared to “treated and controlled,” relative to White participants, even after full adjustment. Black participants were more aware of their HTN. Among 2,906 normotensive participants with follow-up data, Black participants had the highest HTN incidence, which, although attenuated, remained significant after full adjustment. The higher incidence for Hispanic participants was not significant after full adjustment. Conclusion: Adjustment for socioeconomic, lifestyle, and psychosocial factors substantially reduced the magnitude of racial and ethnic disparities in HTN outcomes, suggesting a significant contribution of these factors. These findings underscore the importance of addressing barriers to improve HTN outcomes.

Background: Prediabetes and diabetes are associated with increased risk for hypertension (HTN) and cardiovascular disease, especially in women. Relations of glycemic variability and other glycemic phenotypes with these diseases have not been well studied in individuals without diabetes. Methods: Framingham Heart Study (FHS) Third Generation, New Offspring Spouse, and Omni 2 participants attending Exam 4 Year 1 (n=1291) were invited to wear a Dexcom G6 Pro continuous glucose monitor (CGM) for 10 days. We included individuals who wore CGM for ≥3 full days (n=1038). Participants were excluded if they had diabetes, took glucose-lowering medication (n=133) or did not complete a mixed meal tolerance test (MMTT, n=53), resulting in a final analytic sample of 852 participants. We performed multivariable linear and logistic regression to examine associations of glucose measures (fasting and 2h-post MMTT) and CGM-metrics with blood pressure (BP) variables and prevalent HTN (defined as stage 2 HTN or taking BP medication). We standardized all predictors to 1SD, log-transformed CGM time above range &gt;140mg/dL (TAR140), and adjusted all regression models for age, smoking status, and body mass index (BMI), stratifying by sex. Results: Among 852 FHS participants (56.9% women; average age 60.3 years), the average BMI was 27.9 kg/m 2 , and 30.5% had hypertension. In multivariable regression models, TAR140, mean CGM glucose, and higher blood glucose at fasting and 2h-MMTT were associated with higher odds of HTN (OR=1.20-1.38, all p&lt;0.05). Among those without HTN (n=583), exploratory heatmaps (Figure) provide visualization of the unadjusted correlations of CGM and blood glucose related metrics with BP measures. In multivariable regression models in men and women without HTN (n=583), fasting and 2h-MMTT blood glucose were associated with systolic BP (β=1.65-2.56, p&lt;0.001). In women only, TAR140, mean CGM glucose, coefficient of variation (CV), mean amplitude of glycemic excursion (MAGE), and mean of daily differences (MODD) were associated with pulse pressure (β=0.97-1.31, all p&lt;0.05) and TAR140, mean CGM glucose, and MODD were also associated with systolic BP (β=1.54-1.94, all p&lt;0.01). These associations were not significant in men (β=-0.56-0.28, all p&gt;0.5). Conclusions: Among individuals without diabetes or HTN, associations of CGM metrics with BP measures were observed in women, not in men, which may reveal mechanistic differences in cardiometabolic disease progression by sex.

Background: Environmental contributors to sudden death are not well understood but should inform emergency preparedness and mitigation strategies. We examined flood and pollution risk and sudden death from 2018 to 2021 in Lenoir, a rural North Carolina County which suffered extensive damage from recent hurricanes, most notably Hurricane Matthew in 2016. Research Aim: Determine if census tracts with greater flood or pollution risk have higher sudden death rates. Methods: We identified sudden deaths among adults aged 18-64 from death certificates using a published algorithm (Figure 1). We geocoded decedents’ addresses and linked them to census tract-level data from the EPA Climate and Economic Justice Screening Tool and American Community Survey. Flood risk was defined as the percentage of census tract residents at high (&gt;25%) flood risk over the next 30 years, and pollution risk as the percentage of residents ≤1 mile from a Toxic Release Inventory site. We compared census tract-level sudden death rates by flood and pollution risk levels using incidence rate ratios (IRRs) estimated with Poisson regression, adjusted for racial distribution, median household income, and prevalence of coronary heart disease, diabetes, and hypertension. Results: Among the 15 census tracts in the county, the median flood risk was 10% (range 4 to 16), and the median pollution risk was 8.4% (range 0 to 56.54). Of the 15 tracts, 2 were in the highest tertile for both flood and pollution risk. There were 242 sudden deaths in Lenoir County during the study period, a rate of 437 per 100,000. Tract-level sudden death rates ranged from 246 to 1,130 per 100,000 (Figure 2). Every increase of 10 percentage points in flood risk was associated with a 92% increase in sudden death rates (IRR 1.92, 95 % CI 1.40–2.64). Every 10-point increase in pollution risk was associated with a 14% increase in sudden death (IRR 1.14, 95 % CI 1.04–1.23) (Table 1). Being in the highest risk tertiles for both flood and pollution was associated with higher sudden death rates compared to being in the lowest tertiles for both (IRR 2.02, 95% CI 1.50-2.66). Conclusions: Flood and industrial pollution risk were associated with higher sudden death rates within a rural county, even after accounting for socioeconomic and cardiometabolic burden. Locally-targeted environmental hazard preparedness and mitigation should be evaluated to prevent sudden deaths in vulnerable communities.

Background: Elevated blood pressure (BP) presents a major challenge in sub-Saharan (SSA), affecting ~1 in 10 people. The left ventricle (LV) adapts to chronic pressure overload with hypertrophy and later dilation resulting in diastolic and, subsequently, systolic dysfunction, both of which predispose to pulmonary hypertension (PH). When present, PH contributes to decreased quality of life, reduced exercise capacity, and shortened lifespan. To date, no reports on the prevalence of PH in hypertensive heart failure (HHF) exist, but profiling this is a major step toward population health initiatives aimed at mitigating the PH-HHF burden in low-resource regions. Methods: We conducted a systematic literature search following PRISMA and GATHER guidelines searching PubMed, Embase, Web of Science, and LILACS for studies published until 09/2023 on patients in SSA with diagnosed HHF who underwent echocardiography. HHF was defined as BP&gt;180/100mmHg, accompanied by symptoms of HF, increased LV septal thickness (&gt;13mm), and systolic (LV ejection fraction [EF] &lt;50%) or diastolic (EF≥50% and E/A&lt;1) dysfunction. PH was defined as mild (tricuspid regurgitation velocity [TRV] &gt;2.8m/s) or severe (&gt;3.4m/s). We excluded studies without a clear PH definition and performed a meta-analysis using a random-effects model of proportions. All studies were assessed for risk of bias. Results: We included N=7 studies, published between 2008–2019, compromising N=1,173 patients (mean age, 54±3 years; male, 53±16%). There were n=3 studies (n=371 patients) and n=4 studies (n=802) that analyzed systolic (mean EF 53±16%) and diastolic (EF 33±15%) HHF, respectively. Of all studies, n=6 (86%) and n=1 (14%) studies originated from lower-middle and upper-middle income countries, respectively and all studies (100%) were hospital-based using a prospective, single-centre design. Risk of bias was low in all studies. The estimated prevalences of mild and severe PH were 40.3% (95%CI: 21.7–60.4%; from 7 studies; Figure 1a) and 26.3% [95%CI: 9.8–47.1%] from 5 studies; Figure 1b), respectively. Decreased EF was associated with significantly increased PH prevalence estimates (p=0.032; Figure 1c). Conclusion: PH prevalence is common in HHF and dependent on LV function. There is an urgent need for improved preventative cardiac health programs in SSA that aim at population screening and treatment of elevated BP to reduce PH burden in, and improve outcomes and quality of life of, at-risk patients.