Self-reported Antihypertensive Medication Research Articles

Abstract P323: Awareness of Recent Blood Pressure Levels and Blood Pressure Goals Among US Adults With Diabetes - National Health and Nutrition Examination Survey 2013-2020

Background: Reducing blood pressure (BP) is important for decreasing cardiovascular disease risk among adults with diabetes. Individuals with diabetes are recommended to know their BP level and BP goal. Methods: We used data from the 2013-2020 National Health and Nutrition Examination Surveys (NHANES) for US adults with diabetes (N=2,344). Diabetes was defined as having a prior diagnosis with use of insulin or glucose-lowering medication. Participants with diabetes were asked their most recent BP and their goal BP according to their doctor. Hypertension was defined as systolic/diastolic BP ≥140/90 mm Hg or self-reported antihypertensive medication use. Poisson regression with robust variance estimation was used to estimate associations of participant characteristics with knowing their recent BP level and BP goal for those without hypertension and with hypertension, separately. All analyses accounted for the NHANES complex survey design and were weighted to represent US adults with diabetes. Results: Among US adults with diabetes, 69.8% reported that they knew their recent BP level and 41.5% reported they knew their BP goal. Among those without hypertension and with hypertension, 58.7% and 75.5% reported knowing their recent BP level and 27.5% and 48.5%, respectively, reported knowing their BP goal, respectively. Among adults without hypertension and those with hypertension, non-Hispanic Black or Hispanic versus non-Hispanic White adults, with less than high school education, and without insurance were less likely to know their recent BP ( Table ). Hispanic versus non-Hispanic White adults without hypertension and adults with less than a high school education with hypertension were less likely to know their BP goal. Conclusion: Low percentages of US adults with diabetes knew their BP level and knew their BP goal.

Antihypertensive medication nonadherence and target organ damage in children with chronic kidney disease.

Nonadherence is common in children with chronic kidney disease (CKD). This may contribute to inadequate blood pressure control and adverse outcomes. This study examined associations between antihypertensive medication nonadherence, ambulatory blood pressure monitoring (ABPM) parameters, kidney function, and cardiac structure among children with CKD. We performed secondary analyses of data from the CKD in Children (CKiD) study, including participants with treated hypertension who underwent ABPM, laboratory testing, and echocardiography biannually. Nonadherence was defined by self-report of any missed antihypertensive medication 7days prior to the study visit. Linear regression and mixed-effects models were used to assess the association of nonadherence with baseline and time-updated ABPM profiles, estimated glomerular filtration rate (eGFR), urine protein to creatinine ratio (UPCR), and left ventricular mass index (LVMI). Five-hundred and eight participants met inclusion criteria, followed for a median of 2.9years; 212 (42%) were female, with median age 13years (IQR 10-16), median baseline eGFR 49 (33-64) ml/min/1.73m2 and median UPCR 0.4 (0.1-1.0) g/g. Nonadherence occurred in 71 (14%) participants. Baseline nonadherence was not significantly associated with baseline 24-h ABPM parameters (for example, mean 24-h SBP [β - 0.1, 95% CI - 2.7, 2.5]), eGFR (β 1.0, 95% CI - 0.9, 1.2), UCPR (β 1.1, 95% CI - 0.8, 1.5), or LVMI (β 0.6, 95% CI - 1.6, 2.9). Similarly, there were no associations between baseline nonadherence and time-updated outcome measures. Self-reported antihypertensive medication nonadherence occurred in 1 in 7 children with CKD. We found no associations between nonadherence and kidney function or cardiac structure over time. A higher resolution version of the Graphical abstract is available as Supplementary information.

PCR150 Effects of Smoking on the Prevalence of Self-Reported Antihypertensive Medication Use Among Community-Dwelling Stroke Survivors

To evaluate the effects of cigarette smoking on the prevalence of antihypertensive medication use among community-dwelling stroke survivors.

Sociodemographic and behavioral factors associated with controlled hypertension after 9 years of observation of a PURE Poland cohort study.

Despite some improvement in awareness and treatment of hypertension, blood pressure control is still below expectations in Poland. The aim of the study was to analyze the secular trend of hypertension prevalence in the PURE Poland cohort study over 9 years of observation and to analyze factors associated with controlled HT. The study group consisted of 1,598 participants enrolled in a Prospective Urban and Rural Epidemiological Study (PURE), who participated both in baseline (2007-2010) and 9-year follow-up (2016-2019). Hypertension was ascertained on the basis of (1) self-reported hypertension previously diagnosed by the physician, (2) self-reported anti-hypertensive medication, and/or (3) an average of two blood pressure measurements ≥140 mmHg systolic BP and/or ≥90 mmHg diastolic BP. The prevalence of hypertension increased from 69.4% at baseline to 85.9% at 9-year follow-up. The chance of HT was 8.6-fold higher in the oldest vs. the youngest age group [OR 8.55; CI 4.47-16.1]. Male sex increased the chance for hypertension over 3-fold [OR 3.23; CI 2.26-4.73]. Obesity, according to BMI, increased the chance of HT 8-fold [OR 8.01; CI 5.20-12.8] in comparison with normal body weight. Male sex decreased the chance of controlled HT after 9 years [OR 0.68; CI 0.50-0.92]. There was no statistically significant association between controlled HT and age or place of residence. Higher and secondary education increased the chance of controlled HT over 2-fold in comparison with primary education [OR 2.35; CI 1.27-4.34, OR 2.34; CI 1.33-4.11]. Obesity significantly decreased the chance of controlled HT after 9 years in comparison with normal body weight [OR 0.54; CI 0.35-0.83]. Factors significantly increasing the chance for controlled hypertension after 9 years were female sex, secondary and tertiary education, normal body weight, and avoiding alcohol drinking. Changes in lifestyle, with special emphasis on maintaining normal body weight, should be the basis of prevention and control of HT.

Hypertension Statistics for US Adults: An Open-Source Web Application for Analysis and Visualization of National Health and Nutrition Examination Survey Data.

Data from the US National Health and Nutrition Examination Survey are freely available and can be analyzed to produce hypertension statistics for the noninstitutionalized US population. The analysis of these data requires statistical programming expertise and knowledge of National Health and Nutrition Examination Survey methodology. We developed a web-based application that provides hypertension statistics for US adults using 10 cycles of National Health and Nutrition Examination Survey data, 1999 to 2000 through 2017 to 2020. We validated the application by reproducing results from prior publications. The application's interface allows users to estimate crude and age-adjusted means, quantiles, and proportions. Population counts can also be estimated. To demonstrate the application's capabilities, we estimated hypertension statistics for noninstitutionalized US adults. The estimated mean systolic blood pressure (BP) declined from 123 mm Hg in 1999 to 2000 to 120 mm Hg in 2009 to 2010 and increased to 123 mm Hg in 2017 to 2020. The age-adjusted prevalence of hypertension (ie, systolic BP≥130 mm Hg, diastolic BP≥80 mm Hg or self-reported antihypertensive medication use) was 47.9% in 1999 to 2000, 43.0% in 2009 to 2010, and 44.7% in 2017 to 2020. In 2017 to 2020, an estimated 115.3 million US adults had hypertension. The age-adjusted prevalence of controlled BP, defined by the 2017 American College of Cardiology/American Heart Association BP guideline, among nonpregnant US adults with hypertension was 9.7% in 1999 to 2000, 25.0% in 2013 to 2014, and 21.9% in 2017 to 2020. After age adjustment and among nonpregnant US adults who self-reported taking antihypertensive medication, 27.5%, 48.5%, and 43.0% had controlled BP in 1999 to 2000, 2013 to 2014, and 2017 to 2020, respectively. The application developed in the current study is publicly available at https://bcjaeger.shinyapps.io/nhanesShinyBP/ and produced valid, transparent and reproducible results.

Prevalence, phenotypic characteristics and prognostic role of apparent treatment resistant hypertension in the German Chronic Kidney Disease (GCKD) study.

Treatment resistant hypertension (TRH) appears of particular relevance in patients with chronic kidney disease (CKD). However, causes and consequences of TRH in CKD patients remain incompletely understood. Therefore, we analyzed the prevalence of apparent TRH (aTRH), and phenotypic characteristics and prognosis associated with aTRH among participants of the German Chronic Kidney Disease (GCKD) study. As insufficient medication adherence has been shown to be a frequent cause of pseudoresistance, we also assessed treatment adherence. Study participants were classified as having aTRH, controlled hypertension and uncontrolled hypertension based on study visit blood pressure and self-reported medication intake. Drug adherence was assessed by comparing self-reported antihypertensive medication with detectable urinary drug metabolites measured by mass spectroscopy. Out of 4901 individuals included in this study, 38% were classified as having aTRH. Male sex, older age, lower estimated glomerular filtration rate (eGFR), higher body mass index (BMI), higher urine albumin-to-creatinine ratio (UACR) and presence of diabetes mellitus were independently associated with higher prevalence of aTRH in a multivariable adjusted regression model. Patients classified as aTRH had higher risk for major adverse cardiovascular events and worsening of kidney disease compared to patients with no aTRH after multivariate adjustment for potential confounders. There was a high agreement between self-reported medication and detectable urinary drug metabolites. In conclusion, in a cohort of Caucasian patients with moderately severe CKD, aTRH was highly prevalent and, in most cases, likely not caused by low medication adherence. Furthermore, aTRH was linked to cardio-renal endpoints, emphasizing the need for improved management.

Relationship between social support and incident hypertension in the Jackson Heart Study: a cohort study

ObjectivesSocial support may be an important mitigating factor against adverse cardiovascular outcomes by facilitating health-promoting behaviours or by buffering against the negative effects of stress. This study examined the association...

Abstract 056: Inflammatory Cytokines And Incident Hypertension In The REasons For Geographic And Racial Differences In Stroke (REGARDS) Study

Background: Higher C-reactive protein (CRP) is a risk factor for incident hypertension, but this non-specific inflammatory biomarker does not provide insight into specific immune pathways of hypertension. Here, we studied the role of selected cytokines in risk of incident hypertension to better elucidate these pathways. Objective: To determine the risk for incident hypertension disease among adults by level of IL-1β, IL-6, TNF-α, and IFN-γ. Methods: REGARDS recruited 30,239 Black and White adults aged ≥45 years from the 48 contiguous states in 2003-07. The Biomarkers as Mediators of Racial Disparities in Risk Factors (BioMedioR) substudy included 4,400 sex-race stratified REGARDS participants who also attendd a visit in 2013-16. We excluded those in BioMedioR with prevalent hypertension: 140/90 mm Hg threshold or self-reported antihypertensive medication use. Serum ELISAs assessed cytokines. Modified Poisson regression estimated relative risk (RR) of incident hypertension by detectable threshold (IL-1β; >0.06 pg/mL) or cytokine tertiles (tertile thresholds [33 rd & 66 th %iles] in pg/mL: IL-6, 0.56 & 0.94; TNF-α, 1.30 & 1.69; IFN-γ, 4.01 & 6.56). IL-1β was stratified on race because of a statistically significant interaction. Results: Among the 1,877 participants at risk for incident hypertension (mean [SD] age 62 [8] years, 36% Black race, 51% women), incident hypertension occurred in 31% of White adults and 45% of Black adults. With full adjustment ( Figure ), higher TNF-α and IFN-γ in everyone, and detectable IL-1β in White but not Black adults, were associated with greater incident hypertension risk. There was no association of higher IL-6 with incident hypertension. Conclusions: Among Black and White adults without prevalent hypertension, higher TNF-α, and IFN-γ, and detectable IL-1β (among White but not Black adults), were associated with greater risk of incident hypertension. Future basic and clinical research should study these inflammatory pathways toward developing hypertension prevention strategies.

Self-Reported Antihypertensive Medication Class and Temporal Relationship to Treatment Guidelines.

The greater antihypertensive responses to initial therapy with calcium channel blockers (CCBs) or thiazide-type diuretics than renin-angiotensin system blockers as initial therapy in non-Hispanic Black (NHB) adults was recognized in the US High BP guidelines from 1988 to 2003. The 2014 Report from Panel Members Appointed to the Eighth Joint National Committee (2014 aJNC8 Report) and the 2017 American College of Cardiology/American Heart Association High Blood Pressure Guideline were the first to recommend CCBs or thiazide-type diuretics rather than renin-angiotensin system blockers as initial therapy in NHB. We assessed the temporal relationship of these recommendations on self-reported CCB or thiazide-type diuretics monotherapy by NHB and NHW adults with hypertension absent compelling indications for β-blockers or renin-angiotensin system blockers in National Health and Nutrition Examination Surveys 2015 to 2018 versus 2007 to 2012 (after versus before 2014 aJNC8 Report). CCB or thiazide-type diuretics monotherapy was unchanged in NHW adults (17.1% versus 18.1%, P=0.711) and insignificantly higher after 2014 among NHB adults (43.7% versus 38.2%, P=0.204), although CCB monotherapy increased (29.5% versus 21.0%, P=0.021) and renin-angiotensin system blocker monotherapy fell (44.5% versus 31.0%, P=0.008). Although evidence-based CCB monotherapy increased among NHB adults in 2015 to 2018, hypertension control declined as untreated hypertension and monotherapy increased. While a gap between recommended and actual monotherapy persists, evidence-based monotherapy appears insufficient to improve hypertension control in NHB adults, especially given evidence for worsening therapeutic inertia. Initiating treatment with single-pill combinations and timely therapeutic intensification when required to control hypertension are evidence-based, race-neutral options for improving hypertension control among NHB adults.

Association between cognitive function and self-reported antihypertensive medication adherence among middle-aged and older hypertensive women.

This study applied a cross-sectional, descriptive correlational design. The purpose of the study was to examine the relationship between cognitive function and self-reported antihypertensive medication adherence in middle-aged and older hypertensive women. Although medication adherence is an essential key for preventing complications from hypertension, poor medication adherence is common among middle-aged and older hypertensive women. Taking medications involves a cognitive process. Little is known about the contribution of cognitive function to adherence to antihypertensive medication in middle-aged and older women. This study used a convenience sample of 137 women aged ≥50years recruited from a medical centre in southern Taiwan. Participants completed a survey of demographic and clinical information and self-reported medication adherence, and received cognitive function tests. Hierarchical regression analyses were used to evaluate the association between cognitive function and medication adherence. This study followed the STROBE guidelines. More than one-fourth of the women (27%) reported poor adherence. Women with poor adherence appeared to have a significantly lower memory than women with good adherence. Memory was positively associated with antihypertensive medication adherence after controlling for age, blood pressure and duration of hypertension. Working memory, executive function and psychomotor speed were not significantly related to antihypertensive medication adherence. Reduced memory function was associated with poorer antihypertensive medication adherence among middle-aged and older women. Middle-aged and older women with hypertension and poor memory performance are at risk of poor medication adherence. Future prospective studies examining the causal relationship between cognitive function and antihypertensive medication adherence are warranted. Nurses could evaluate the memory of middle-aged and older hypertensive women when assessing antihypertensive medication adherence in clinical practice and provide relevant interventions.

Prevalence of multimorbidity of cardiometabolic conditions and associated risk factors in a population-based sample of South Africans: A cross-sectional study

ObjectivesAgeing populations have led to a growing prevalence of multimorbidity. Cardiometabolic multimorbidity (CM), the co-existence of two or more cardiometabolic disorders in the same person, is rapidly increasing. We examined the prevalence and risk factors associated with CM in a population-based sample of South African adults. Study designData were analysed on individuals aged ≥15 years from the South African National Health and Nutrition Examination Survey (SANHANES), a cross sectional population-based survey conducted in 2011–2012. MethodsCM was defined as having ≥2 of hypertension, diabetes, stroke and angina. Hypertension was defined as blood pressure ≥140/90 mmHg or self-reported antihypertensive medication use. Diabetes was defined by HbA1c ≥ 6.5% or self-reported medication use. Stroke and angina were assessed by self-report. Multivariable logistic regression was used to investigate the sociodemographic and modifiable risk factors associated with CM. The association of CM with the functional status of individuals was examined using logistic regression, where functional status was measured by the WHO DAS 2.0 12-item instrument. ResultsOf the 3832 individuals analysed, the mean age was 40.8 years (S.D. 18.3), 64.5% were female and 18% were ≥60 years. The prevalence of CM was 10.5%. The most prevalent CM cluster was hypertension and diabetes (7.3%), followed by hypertension and angina (2.6%) and hypertension and stroke (1.9%). Of the individuals with diabetes, nearly three quarters had multimorbidity from co-occurring hypertension, angina and/or stroke and of those with hypertension, 30% had co-occurring diabetes, angina and/or stroke. Age (30–44 years Adjusted Odds Ratio (AOR) = 2.68, 95% CI: 1.15–6.26), 45–59 years AOR = 16.32 (7.38–36.06), 60–74 years AOR = 40.14 (17.86–90.19), and ≥75 years AOR = 49.54 (19.25–127.50) compared with 15–29 years); Indian ethnicity (AOR = 2.58 (1.1–6.04) compared with black African ethnicity), overweight (AOR = 2.73 (1.84–4.07)) and obesity (AOR = 4.20 (2.75–6.40)) compared with normal or underweight) were associated with increased odds of CM. When controlling for age, sex and ethnicity, having ≥2 conditions was associated with significantly higher WHO DAS percentage scores (β = 5.4, S.E. = 1.1, p < 0.001). ConclusionsA tenth of South Africans have two or more cardiometabolic conditions. The findings call for immediate prioritisation of prevention, screening and management of cardiometabolic conditions and their risk factors to avert large scale health care costs and adverse health outcomes associated with multimorbidity.

Relationship between Sleep and Hypertension: Findings from the NHANES (2007-2014).

Background: To evaluate the association of sleep factors (sleep duration, self-reported trouble sleeping, diagnosed sleep disorder) and combined sleep behaviors with the risk of hypertension. Methods: We analyzed 12,166 adults aged 30–79 years who participated in the 2007–2014 National Health and Nutrition Examination Survey. Sleep duration, self-reported trouble sleeping and sleep disorders were collected using a standardized questionnaire. We included three sleep factors (sleep duration, self-reported trouble sleeping and sleep disorder) to generate an overall sleep score, ranging from 0 to 3. We then defined the sleep pattern as “healthy sleep pattern” (overall sleep score = 3), “intermediate sleep pattern” (overall sleep score = 2), and “poor sleep pattern” (0 ≤ overall sleep score ≤ 1) based on the overall sleep score. The definition of hypertension was based on self-reported antihypertensive medication use or biological measurement (systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg). We used weighted logistic regression models to investigate the associations between sleep and hypertension. Results: The overall prevalence of hypertension was 37.8%. A short sleep duration (OR = 1.20, 95% CI: 1.08 to 1.33, p = 0.001), self-reported trouble sleeping (OR = 1.45, 95% CI: 1.28 to 1.65, p < 0.001) and sleep disorder (OR = 1.33, 95% CI: 1.07 to 1.66, p = 0.012) were related to the risk of hypertension. Poor sleep patterns were closely correlated with the risk of hypertension (OR = 1.90, 95% CI: 1.62 to 2.24). Conclusions: Participants with poor sleep patterns were associated with an increased risk for hypertension.

Abstract P188: Anxiety Is Associated With Six-year Blood Pressure Change And Incident Hypertension: Findings From The Hispanic Community Health Study/ Study Of Latinos

Introduction: Prior research on the association of anxiety with hypertension has yielded mixed results. Despite the high burden of both conditions in Hispanics/Latinos, little is known about their association in this population. This study examined the longitudinal relationship of trait anxiety with changes in BP and incidence of hypertension. Hypothesis: Higher trait anxiety at Visit 1 (V1) will be associated with greater increases in BP and incident hypertension over 6 years. Methods: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) is a multi-center prospective community-based study of 16,415 diverse Hispanics/Latinos ages 18-74 at V1 (2008-11). Data included 11,048 participants with complete information on BP, trait anxiety, and other variables at V1 and V2 (2014-17). Trait anxiety was measured at V1 using the 10-item Spielberger Trait Anxiety Scale, which was dichotomized into low and high using a cut-point of 20 points, the top quartile in the HCHS/SOL cohort. BP was measured using a standardized protocol and validated automated device. Hypertension was defined as systolic BP ≥ 140 or diastolic BP ≥ 90 mm Hg or self-reported antihypertensive medication use. Linear regressions were used to examine the association of anxiety with BP change; to account for medication use, 9 mmHg and 6 mmHg were added to systolic and diastolic BP of treated participants, respectively. The association of anxiety with incident hypertension at V2 was examined using Poisson regression among those without hypertension at V1 ( N = 7,878). Estimates were adjusted for complex survey design, sociodemographic factors, baseline BP, antidepressant/anxiolytic medication use, and health conditions. Results: Mean baseline age was 45.8 years and 60% were women. Mean change was 3.13 ( SE = 15.67) in systolic and 0.21 ( SE = 9.73) in diastolic BP. Individuals with high, compared to those with low, trait anxiety had greater increases in systolic ( B = 1.10, 95% CI = 0.28-1.93, p = 0.009) and diastolic BP ( B = 0.69, 95% CI = 0.11-1.27, p = 0.02) over 6 years, after adjusting for covariates. Individuals with high, relative to those with low, trait anxiety had an 18% higher risk of hypertension (RR = 1.18, 95% CI = 1.03-1.34, p = 0.012). Conclusions: Elevated trait anxiety is associated with small increases in BP over 6 years and an 18% higher risk of hypertension among diverse Hispanics/Latino adults. Research on the mechanisms underlying these relationships among Hispanics/Latinos is warranted to develop effective interventions to prevent and treat hypertension in this population.

PREDIABETES AND RISKS FOR ALL-CAUSE AND CARDIOVASCULAR MORTALITY BY HYPERTENSION STATUS: RESULTS FROM THE NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEYS

Objective: Current recommendation suggests prediabetes testing for adults with overweight or obesity who have at least one cardiovascular risk factor. Given the detrimental effects of combined prediabetes and hypertension on CVD events, it is important to understand whether testing should be conducted for adults with hypertension regardless of other cardiovascular risk factors Design and method: Participants from the 1999–2014 National Health and Nutrition Examination Surveys (NHANES) aged over 18 years without diabetes were enrolled for analysis. Participants were classified according to their status of prediabetes and hypertension, and followed up for cardiovascular and all-cause mortality till 31 December 2015. Cox proportional hazards models were built to estimate the hazard ratios (HR) for all-cause and cardiovascular mortality among participants with prediabetes, hypertension, and both. Results were also stratified by age, gender and demographic backgrounds to explore subgroup differences in associations. Results: A total of 34,047 participants with median follow-up period of 8.4 years were included in analysis. Prediabetes was defined as fasting plasma glucose between 100 and 125 mg/dL, or hemoglobin A1c between 5.7 and 6.4%, or self-reported hypoglycemic drug use. Hypertension was defined as systolic/diastolic blood pressure over 140/90 mmHg and/or self-reported antihypertensive medication use. At baseline, 5011 (14.7%) of them had combined prediabetes and hypertension. When compared with participants without prediabetes nor hypertension, prediabetes alone was not associated with all-cause (HR [95% CI]: 1.12 [0.93, 1.34]) nor with cardiovascular mortality (1.30 [0.74, 2.29]); hypertension alone was significantly associated with all-cause (HR [95% CI)]: 1.30 [1.11, 1.52]) and cardiovascular mortality (1.97 [1.22, 3.16]); combined prediabetes and hypertension was significantly associated with all-cause mortality (HR [95% CI]): 1.40 [1.19, 1.65]) and cardiovascular mortality (2.40 [1.49, 3.85]).According to subgroup analysis, participants with combined prediabetes and hypertension had a higher risk of all-cause mortality among those aged &lt; 60 (HR: 2.19), White population (HR: 1.41) and male participants (HR:1.52). Conclusions: Prediabetes might elevate the risks of all-cause and cardiovascular mortality among people with hypertension.

Association Between Cost-Related Medication Nonadherence and Hypertension Management Among US Adults.

Medication nonadherence is an important element of uncontrolled hypertension. Financial factors frequently contribute to nonadherence. The objective of this study was to examine the association between cost-related medication nonadherence (CRMN) and self-reported antihypertensive medication use and self-reported normal blood pressure among US adults with self-reported hypertension. Participants with self-reported hypertension from the 2017 National Health Interview Survey were included (n = 7,498). CRMN was defined using standard questions. Hypertension management included: (i) self-reported current antihypertensive medication use and (ii) self-reported normal blood pressure within the past 12 months. Adjusted prevalence and prevalence ratios of hypertension management indicators among those with and without CRMN were estimated. Overall, 10.7% reported CRMN, 83.6% reported current antihypertensive medication use, and 67.4% reported normal blood pressure within past 12 months. Adjusted percentages of current antihypertensive medication use (88.6% vs. 82.9%, P < 0.001) and self-reported normal blood pressure (69.8% vs. 59.5%, P = 0.002) were higher among those without CRMN compared with those with CRMN. Adjusted prevalence ratios showed that, compared with those with CRMN, those without CRMN were more likely to report current antihypertensive medication use (odds ratio = 1.08, 95% confidence interval 1.04-1.12) and self-reported normal blood pressure (1.15 (1.07-1.23)). Among US adults with self-reported hypertension, those without CRMN were more likely to report current antihypertensive medication use and normal blood pressure within the past 12 months. Financial barriers to medication adherence persist and impact hypertension management.

Prevalence of Self-Reported Hypertension and Antihypertensive Medication Use Among Adults - United States, 2017.

Hypertension, or high blood pressure, is a major risk factor for heart disease and stroke (1). The prevalence of hypertension is higher among men than among women, increases with age, is highest among non-Hispanic blacks (blacks) (2), and has been consistently highest in the Southeastern region of the United States (1). To update prevalence estimates for self-reported hypertension and use of antihypertensive medication, CDC analyzed data from the 2017 Behavioral Risk Factor Surveillance System (BRFSS). The overall (unadjusted) prevalence of self-reported hypertension was 32.4% (95% confidence interval [CI]=32.1%-32.7%). The age-standardized, median state-specific prevalence of self-reported hypertension was 29.7% (range=24.3%-38.6%). Overall age-standardized hypertension prevalence was higher among men (32.9%) than among women (27.0%), highest among blacks (40.0%), decreased with increasing levels of education and household income, and was generally highest in the Southeastern and Appalachian states.* Among persons reporting hypertension, the overall unadjusted prevalence of self-reported antihypertensive medication use was 76.0% (95% CI=75.5%-76.4%). The age-standardized, median state-specific prevalence of antihypertensive medication use among persons with reported hypertension was 59.4% (range=50.2%-71.2%). Prevalence was higher among women than men, highest among blacks compared with other racial/ethnic groups, and highest among states in the Southeast, Appalachia, and the Dakotas. These findings can help inform CDC's initiatives to enhance hypertension awareness, treatment, and control across all states.

Relationship between low-level lead, cadmium and mercury exposures and blood pressure in children and adolescents aged 8–17 years: An exposure-response analysis of NHANES 2007–2016

This study investigated whether low-level blood and urinary lead, cadmium and mercury exposures were associated with blood pressure (BP) in children and adolescents. Data from National Health and Nutrition Examination Survey (NHANES) between 2007 and 2016 for children and adolescents aged 8–17 years (n = 7076) were analyzed. Outcome variables were systolic BP, diastolic BP and high BP status. High BP was defined as: self-reported antihypertensive medication usage or a diagnosis of hypertension; classified as having elevated BP/hypertension according to 2017 AAP guidelines. Multivariable linear and logistic regressions models were performed and stratified by race/ethnicity and gender. Blood lead was negatively associated with diastolic BP among blacks, and positively associated with diastolic BP among whites. For a two-fold increase of blood lead concentration, the change in diastolic BP was −1.59 mm Hg (95% CI: −3.04 to −0.16 mm Hg) among blacks and 1.38 mm Hg (95% CI: 0.40 to 2.36 mm Hg) among whites. No significant associations between either systolic BP or diastolic BP with urinary lead were observed. The inverse associations between blood lead and high BP were found in females, Mexican Americans and other Hispanics. No associations between blood cadmium and BP were observed, except in other Hispanics. Urinary cadmium levels were inversely correlated with systolic BP, diastolic BP and high BP in all participants and in men. When compared to the lowest quartile of urinary cadmium levels, participants with a urinary cadmium level ≥ 0.12 μg/L had 0.48 (95% CI: 0.29–0.78) times and 0.53 (95% CI: 0.30–0.94) times reduced odds of having high BP in all participants and in men, respectively. No associations between either blood mercury or urinary mercury with systolic BP were observed. Significant inverse associations were found between blood total mercury and methyl mercury with diastolic BP in all participants and in men. Future prospective studies are warranted to confirm these findings.

Effect of Home Blood Pressure Monitoring via a Smartphone Hypertension Coaching Application or Tracking Application on Adults With Uncontrolled Hypertension

Mobile applications (apps) may help improve hypertension self-management. To investigate the effect of an artificial intelligence smartphone coaching app to promote home monitoring and hypertension-related behaviors on systolic blood pressure level compared with a blood pressure tracking app. This was a 2-group, open, randomized clinical trial. Participants with uncontrolled hypertension were recruited in 2016 and 2017 and were followed up for 6 months. Data analysis was performed from April 2019 to December 2019. Intervention group participants received a smartphone coaching app to promote home monitoring and behavioral changes associated with hypertension self-management plus a home blood pressure monitor. Control participants received a blood pressure tracking app plus a home blood pressure monitor. The primary study outcome was systolic blood pressure at 6 months. Secondary outcomes included self-reported antihypertensive medication adherence, home monitoring and self-management practices, measures of self-efficacy associated with blood pressure, weight, and self-reported health behaviors. There were 333 participants randomized, and 297 completed the follow-up assessment. Among the participants who completed the study, the mean (SD) age was 58.9 (12.8) years, 182 (61.3%) were women, and 103 (34.7%) were black. Baseline mean (SD) systolic blood pressure was 140.6 (12.2) mm Hg among intervention participants and 141.8 (13.4) mm Hg among control participants. After 6 months, the corresponding mean (SD) systolic blood pressures were 132.3 (15.0) mm Hg and 135.0 (13.9) mm Hg, with a between-group adjusted difference of -2.0 mm Hg (95% CI, -4.9 mm Hg to 0.8 mm Hg; P = .16). At 6 months, self-confidence in controlling blood pressure was greater in the intervention group (0.36 point on a 5-point scale; 95% CI, 0.18 point to 0.54 point; P < .001). There were no significant differences between the 2 groups in other secondary outcomes. The adjusted difference in self-reported physical activity was 26.7 minutes per week (95% CI, -5.4 minutes per week to 58.8 minutes per week; P = .10). Subgroup analysis raised the possibility that intervention effects differed by age. Among individuals with uncontrolled hypertension, those randomized to a smartphone coaching app plus home monitor had similar systolic blood pressure compared with those who received a blood pressure tracking app plus home monitor. Given the direction of the difference in systolic blood pressure between groups and the possibility for differences in treatment effects across subgroups, future studies are warranted. ClinicalTrials.gov Identifier: NCT03288142.

Prediabetes and Risk for Cardiovascular Disease by Hypertension Status in Black Adults: The Jackson Heart Study.

Recent studies have suggested that prediabetes is associated with an increased risk for cardiovascular disease (CVD) only among individuals with concomitant hypertension. We analyzed the association between prediabetes and CVD by hypertension status among 3,313 black adults in the Jackson Heart Study (JHS) without diabetes or a history of CVD at baseline (2000-2004). Prediabetes was defined as fasting plasma glucose between 100 and 125 mg/dL or hemoglobin A1c between 5.7 and 6.4% (39 and 46 mmol/mol). Hypertension was defined as systolic/diastolic blood pressure ≥140/90 mmHg and/or self-reported antihypertensive medication use. Participants were followed for incident CVD events and all-cause mortality through 31 December 2014. Overall, 35% of JHS participants did not have prediabetes or hypertension, 18% had prediabetes alone, 22% had hypertension alone, and 25% had both prediabetes and hypertension. Compared with participants without either condition, the multivariable-adjusted hazard ratios for CVD events among participants with prediabetes alone, hypertension alone, and both prediabetes and hypertension were 0.86 (95% CI 0.51, 1.45), 2.09 (1.39, 3.14), and 1.93 (1.28, 2.90), respectively. Among participants with and without hypertension, there was no association between prediabetes and an increased risk for CVD (0.78 [0.46, 1.34] and 0.94 [0.70, 1.26], respectively). No association was present between prediabetes and all-cause mortality among participants with or without hypertension. Regardless of hypertension status, prediabetes was not associated with an increased risk for CVD or all-cause mortality in this cohort of black adults.

P1946Hypertension prevalence, awareness, treatment and control and 10-year estimated CVD risk in East and West Africa: pooled analysis of data from 4 African countries

Abstract Background Though the prevalence of hypertension is rising in Sub-Saharan Africa, few studies have characterized the epidemiology and management of hypertension across many heterogeneous communities. We assessed prevalence, awareness, treatment and control of hypertension and estimated the 10-year cardiovascular risk across six sites in East and West Africa. Methods Between June and August 2018, we conducted household-based surveys in 6 rural, semi-urban and urban settings in Kenya, Nigeria, Tanzania and Uganda to enroll community-dwelling adults (aged &gt;18 years) collect data including age, gender, smoking, anthropometric measures, health insurance, utilization of health care facilities. We defined hypertension as systolic blood pressure of at least 140 mm Hg, or diastolic blood pressure of at least 90 mm Hg, or self-reported antihypertensive medication use. We used country specific Globorisk prediction equations to estimate 10-year CVD risk. Results A total 3,150 participants with a mean age of 40 years (SD 15), 61% of whom were women, 8% had ever smoked, and 33% were overweight/obese. About 23.7% (95% CI 22.2, 25.2) of the entire sample had hypertension, of whom 60.6% (56.8, 64.3) were diagnosed. Among diagnosed, 61.7% (57.2, 66.1) were taking antihypertensives, and 27.7% (22.7, 33.1) had controlled BP. The prevalence of hypertension was 38.6% in Ikire-Nigeria, 25.1% Ukonga-Tanzania, 23.3% in Oyo-Nigeria, 21.6% in Okpok-Nigeria, 20.4% in Soroti-Uganda, and 9.7% in Viwandani-Kenya. The overall median estimated 10-yr CVD risk was low 4.6% IQR (2.3, 9.6) and 8.6% had 10-yr CVD risk &gt;10%. (Figure 1) Conclusion Among African adults aged &gt;18 years, nearly a quarter have hypertension, three in 5 being treated, and fewer than three in ten had BP under control. The low number of people in control is ubiquitous in all sites and warrants greater prevention strategies, better screening and more effective and affordable treatment options than what is currently available.