Self-reported Antihypertensive Medication Use Research Articles

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 < 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.

Abstract P516: A Traditional Mexican Diet Score is Not Associated With Increased Risk of Hypertension and is Comparable to Other Diet Scores Among U.S. Adults of Mexican Heritage in the Hispanic Community Health Study/Study of Latinos Cohort

Introduction: Little is known about whether prevailing diet quality scores apply to Hispanics/Latinos when assessing hypertension risk or if a diet score applied to a traditional diet would be more relevant. Objective: To compare a traditional Mexican diet score (tMexS) against three prevailing diet quality scores (Mediterranean Diet Score [MeDS], Alternate Healthy Eating Index-2010 [AHEI-2010], and Dietary Approaches to Stop Hypertension [DASH]) in association with risk of hypertension and change in systolic and diastolic blood pressure (BP) in adults of Mexican heritage in the U.S. Methods: Data were analyzed from 3,542 U.S. adults of Mexican heritage in the multicenter population-based Hispanic Community Health Study/Study of Latinos (HCHS/SOL) cohort with baseline (2008-2011) and follow-up (2014-2017) visits, and without CVD and hypertension at baseline. Diet quality scores were calculated from the average of two 24-h recalls. Higher scores of MeDS, AHEI-2010, and DASH indicate a healthier diet, while a higher tMexS indicates a more traditional Mexican diet. Hypertension was defined as an average of ≥140 systolic or ≥90 mmHg diastolic BP from triplicate measurements, or self-reported use of antihypertensive medications. Logistic regression models tested the association of four dietary scores with incident hypertension, and linear regression models tested the association of dietary scores and changes in systolic and diastolic BP by hypertension status. Multivariable models with complex survey procedures were adjusted for confounders, and the final model included all dietary scores simultaneously. Results: After an average 6y of follow-up, there were 553 incident cases of hypertension. Mean (±SE) total score was 5.8 ± 0.05 for tMexS (range: 0-12), 5.3 ± 0.04 for MeDS (range: 0-9), 51.4 ± 0.19 for AHEI-2010 (range: 0-110), and 48.5 ± 0.22 for DASH (range: 0-90). The tMexS, MeDS, and DASH were not associated with risk of hypertension. A 10-unit increase in the AHEI-2010 was associated with a lower risk of hypertension (OR: 0.77; 95% CI: 0.60, 0.98). Among normotensive adults, diastolic BP decreased by 0.24 ± 0.11 mmHg per one-unit increase in tMexS (p-value=0.02). No significant changes were noted for systolic BP nor among adults with hypertension. Conclusions: In this prospective cohort, the AHEI-2010, but not DASH, MeDS, or tMexS, was associated with lower hypertension risk among U.S. adults of Mexican heritage, while the tMexS reduced diastolic BP among normotensive adults. To decrease hypertension risk, adults of Mexican heritage should adhere to AHEI-2010 dietary recommendations, while consuming traditional Mexican foods for modest benefits on blood pressure.

Prevalence of hypertension and diabetes in Finland by different data sources

Abstract Background Population level information on the prevalence of hypertension and diabetes is needed to support planning and evaluation of preventive activities and care. Population based health examination surveys (HES) can provide valid information, but they are time consuming and expensive. Administrative registers on hospitalizations and out-patient visits could provide information faster and at less cost. The aim of this study is to estimate how comparable prevalence estimates of type 2 diabetes (T2D), hypertension and their combination are based on data from the Finnish national health examination survey (FinHealth 2017) and data from administrative hospital and primary care registers in Finland. Methods Survey data were linked to care registers using personal identity codes. Survey based hypertension was defined as SBP≥140 mmHg or DBP≥90 mmHg or self-reported use of antihypertensive medications; and T2D as HbA1c ≥48 mmol/mol or self-reported us of diabetes medications. Corresponding indicators from care registers were: hypertension and T2D as a reason for care or visit or having received prescription for diabetes medication (using ICD-10, ICPC and ATC codes). Results For hypertension, survey data provided the prevalence of 43 % while only 12 % of individuals were identified as hypertensives in the register data. The prevalence of T2D was 9 % in both data sources. The prevalence of having both hypertension and T2D was 7 % based on survey data and 3 % based on register data. Agreement between survey and register data was lower for hypertension (Cohen’s kappa 0.23) than for T2D (0.84). Conclusions Register data provided lower prevalence for hypertension than the survey data. For diabetes, similar prevalences were observed. As there are limitations in the coverage of register data more reliable population level information can be obtained from HES. Key messages Health examination surveys cover persons with undiagnosed problems and conditions omitted in national registers. Hypertension and T2D should be monitored with both register and survey data.

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.

Trends in status of hypertension in rural northeast China: results from two representative cross-sectional surveys, 2013-2018.

To investigate the long-term natural trends in the status of hypertension in rural northeast China from 2013 to 2018. Two successive cross-sectional surveys were conducted in Liaoning rural areas in 2013 and 2018, which included 10 753 and 10 926 participants aged at least 40 years from different villages, respectively. A multistage, stratified, and cluster random sampling method was used to ensure that the samples of the two studies were representative. Hypertension was defined as a mean SBP at least 140 mmHg or a mean DBP at least 90 mmHg, and/or self-reported use of antihypertensive medication within the past 2 weeks. The prevalence and control rate of hypertension were also estimated according to the 2017 American College of Cardiology/American Heart Association high blood pressure guideline. Overall, the age-standardized prevalence of hypertension increased from 52.3 to 53.6%, while the age-specified DBP level increased by 5.2% (82.4 vs. 86.7 mmHg) during the study period. However, the control rate unfortunately remained low (4.1 vs. 3.6%), despite unsatisfied awareness and treatment rates of hypertension in rural northeast China. Under the 2017 American College of Cardiology/American Heart Association guideline, the prevalence of hypertension increased from 73.9 to 79.1%; however, the control rate decreased sharply from 1.8 to 0.5% between 2013 and 2018. Despite the high prevalence of hypertension during the past 5 years, blood pressure levels increased significantly, especially the DBP level. Awareness, treatment, and control of hypertension remained unacceptably low. Therefore, strategies targeting the management of hypertension should be emphasized in rural northeast China.

Hypertension among women of reproductive age: Impact of 2017 American College of Cardiology/American Heart Association high blood pressure guideline

ObjectiveTo estimate the prevalence of hypertension and antihypertensive medication recommended among U.S. reproductive-aged women according to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guideline as compared with the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC7) guideline and to identify factors associated with newly classified hypertensive women. MethodsWe analyzed data from the National Health and Nutrition Examination Survey 2005–2014. Hypertension was defined using blood pressure measurements and/or self-reported antihypertensive medication use. Multivariable Poisson regression models with robust error variance were conducted. ResultsAmong 4,575 (weighted n ​= ​40,194,602) non-pregnant women aged 20–44 years, the prevalence of hypertension was 16.5% using the 2017 guideline, and 7.8% based on the JNC7 guideline. Following the 2017 guideline, 8.6% would be recommended for antihypertensive medication, similar to 8.5% according to JNC7 guideline. Following the 2017 guideline, women with older age (35–44 years), obesity, and diabetes were more likely, while Hispanic women were less likely, to be newly classified as hypertensive. ConclusionAmong reproductive-aged women, compared to JNC7 guidelines, the prevalence of hypertension increased by 112% following the 2017 guideline, but the percentage of women recommended for antihypertensive medication was similar.

Frequency of achieving a 'fit' cardiorespiratory fitness level and hypertension: a cohort study.

Although maintaining cardiorespiratory fitness is encouraged to reduce the risk of hypertension, the level at, and length of time for which, individuals need to maintain fitness remains unclear. We examined the association between the frequency of achieving the recommended fitness levels of the 'Physical Activity Reference for Health Promotion 2013' and the risk of hypertension among Japanese men. This cohort study was conducted in 6653 men without hypertension enrolled in 1986. Whether the participants' fitness level was equal to or exceeded the reference value (fit) or not (unfit) was determined. The frequency of achieving the recommended fitness level was calculated by counting the number of times the fitness level was achieved in 1980 through 1986. Incident hypertension was defined as the first visit with a SBP/DBP of at least 140/90 mmHg or self-reported antihypertensive medication use and was evaluated during annual health examinations from 1986 until 2009. During the follow-up period, 3630 men developed hypertension. The multivariable-adjusted hazard ratios (95% confidence interval) for incident hypertension comparing men with fit versus unfit at baseline was 0.79 (0.74-0.85). Moreover, the frequency of achieving the recommended fitness level was inversely associated with the incidence of hypertension. The risk of hypertension was lower among those who achieved three or more of the recommended levels (0.72 for three times to 0.62 for seven times). Achieving the fitness level recommended in the Japanese guideline three or more times during a 6-year period can be beneficial for the risk reduction of hypertension.

Abstract P174: Stress and Depression Are Associated With Life’s Simple 7 Among African Americans With Hypertension: Findings From the Jackson Heart Study

Introduction: The American Heart Association created the Life’s Simple 7 (LS7) metric to promote optimal cardiovascular health (CVH) via managing blood pressure (BP), controlling cholesterol, reducing blood sugar, getting active, eating better, losing weight, and quitting smoking. The degree to which psychosocial factors impact one’s ability to achieve LS7 recommendations is unclear. We hypothesized that hypertensive African Americans with high stress levels and high depressive symptoms would have poorer CVH compared to those with low stress and low depressive symptoms. Methods: Cross-sectional analyses included 1,845 participants with hypertension from the Jackson Heart Study, a community-based cohort of African Americans. Hypertension was defined as clinic BP ≥140/90 mm Hg or self-reported use of antihypertensive medication at the baseline exam (2000-2004). Outcomes were the continuous LS7 composite score and individual components (each defined as poor, intermediate or ideal). The Weekly Stress Inventory was used to identify high stress (top quartile vs. all others). The Center for Epidemiologic Studies Depression (CES-D) scale was used to identify high depressive symptoms (CES-D ≥16 vs. &lt;16). We examined associations between stress and depressive symptoms with composite LS7 scores and individual LS7 metrics. We compared four groups: (1) high stress alone, (2) high depressive symptoms alone, (3) high stress and high depressive symptoms, and (4) low stress and low depressive symptoms (reference). Models were progressively adjusted for age, sex, education, employment, insurance status, and cardiovascular risk factors. Results: The mean age was 58.9 ± 10.8 years, 31% of participants were male, and 9.6% had both high stress and high depressive symptoms. Participants with both high stress and high depressive symptoms had a lower composite LS7 score than those with low stress and low depressive symptoms (6.0 vs. 6.5, p=0.004). The association was present after adjusting for demographic and socioeconomic factors (p=.029) but not in fully adjusted models (p&gt;0.05). Neither high stress alone nor high depressive symptoms alone were associated with LS7 score in any model (p&gt;0.05). Other key findings included significant associations between high stress and depressive symptoms and poorer levels of health for smoking (OR [95% CI]= 0.53 [0.34-0.81]) and physical activity (OR [95% CI]= 0.68 [0.50-0.94]) in fully adjusted models. Conclusion: African Americans with the combination of high stress and high depressive symptoms had poorer overall CVH compared with those reporting low stress and low depressive symptoms, and were less likely to have ideal smoking and physical activity. Future studies should evaluate prospective effects of this psychosocial risk profile on CVH, which may inform behavioral approaches to improving CVH.

Hypertension and physical activity in middle-aged and older adults in China

There are few studies examining the association between levels of physical activity and hypertension in middle-aged and older adults in China. Data were drawn from the Chinese Health and Retirement Longitudinal Study (using four-stage stratified probability-proportional-to-size sampling), involving 7113 individuals aged 45 years and older from 28 provinces of China. Hypertension was defined as a systolic BP ≥ 130 mm Hg, or diastolic BP ≥ 80 mm Hg, or self-reported use of anti-hypertensive medications. The awareness, treatment, and control among hypertensive participants were 53.12%, 43.37%, and 10.03%, respectively. The prevalence of hypertension was 56.12% among all the participants, higher in main city zones (58.68%) than villages (55.52%) and other areas (55.78%, p < 0.0001). Participants who were overweight (BMI ≥ 24: AOR 4.08, 95% CI 3.21–5.20, P < 0.0001; BMI ≥ 28: 10.03, 7.56–13.31, P < 0.0001), and drinking more than once a month (1.28, 1.12–1.46, P < 0.0001) were more likely to have hypertension. The decision tree model was established to analyze the importance of different levels of physical activity on hypertension prevention. Participants who usually participated in moderate-to-vigorous activity for more than 10 minutes (vigorous: 0.82, 0.73–0.91, P = 0.0004; moderate: 0.83, 0.75–0.92, P = 0.0006) were less likely to have hypertension. The results of the decision tree showed that the vigorous physical activity seemed to be more important than moderate and light activity to induce beneficial effects on prevention of hypertension. The strength of our study is in using the decision tree to clearly rank the importance of those key factors affecting hypertension.

A9764 The influence of childhood elevated Blood pressure on the risk of incident Hypertension in young adulthood

Objectives: our study is to investigate the influence of childhood elevated blood pressure (BP) on the risk of incident hypertension in young adulthood. Methods: 2029 subjects aged 6–17 years old were followed from childhood to young adulthood (18–38years) based on China Health and Nutrition Survey (CHNS,1991–2011). Childhood elevated BP was defined according to SBP and/or DBP ≥ 90th percentile for age and sex from Chinese reference. In adulthood, high BP was classified if SBP ≥ 140mmHg, DBP ≥ 90 mmHg, High-normal BP was classified if SBP ≥ 120 mmHg, DBP ≥ 80 mmHg, or self-reported use of antihypertensive medications. Cox proportional hazards models were used to assess the Hazard ratios (HRs) and 95% confidence interval (CI) for the influence of childhood elevated BP on the risk of incident hypertension in young adulthood Results: Children and adolescents with elevated BP had an increased risk of hypertension in young adulthood (hazard ratio, 1.7; 95% confidence interval, 1.1–2.8),as compared with persons who had a normal BP as children and adolescents, as well as (hazard ratio, 2.1; 95% confidence interval, 1.3–3.4) in boys, and (hazard ratio, 3.0; 95% confidence interval, 1.3–6.9) in 6 to 11 years old, but not girls (hazard ratio,0.6;95% confidence interval,0.1–2.8) and 12 to 17 years old (hazard ratio,1.7;95% confidence interval,0.7–2.3) of children and adolescents with elevated BP. In addition, persons who had elevated BP in children and adolescents had risks of pre-hypertension in young adulthood that were similar to the outcomes above. Conclusion: Children and adolescents with elevated BP had increased risks of hypertension in young adulthood, and this association is particularly close in boys and 6 to 11 years old of children and adolescents. We should stress on the monitoring of children BP and provide for preventio

Abstract P162: The Association Between Hypertension and Incident Heart Failure by Race and Gender

Background: Hypertension is a major risk factor for heart failure (HF), but associations of hypertension with HF may vary by race and gender. Objective: To assess race and gender differences in the association between hypertension and incident HF hospitalization in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Methods: REGARDS participants without suspected baseline HF (n = 25,759) were followed from study entry in 2003-2007 through 2014 with adjudication of incident HF hospitalizations (n = 855). Hypertension was defined as systolic or diastolic blood pressure ≥ 140/90 mmHg or self-reported antihypertensive medication use. Cox regression was used to calculate hazard ratios (HR) and 95% confidence intervals (CIs) for the association between hypertension and HF hospitalization in subgroups separately by race or gender, with each subgroup model adjusted for race, gender, age, income, region of residence, health insurance, body mass index, smoking, history of coronary heart disease, diabetes, reduced estimated glomerular filtration rate, total cholesterol, statin use, physical activity, perceived stress, and depressive symptoms. Results: The mean age of the population was 64.5 years, 40.0% were black and 55.0% were female. The prevalence of hypertension was 57.1% and more common among blacks (69.3%) compared to whites (48.9%) but similar among males (56.5%) and females (57.6%). Over a median follow-up of 8.4 years, incidence rates for HF hospitalization were 4.19, 4.46, 5.14 and 4.29 per 1,000 person-years for whites, blacks, males and females, respectively. After multivariable adjustment, the association between hypertension and HF was stronger among blacks versus whites (HR 2.28 vs HR 1.50, p-interaction=0.04) and similar among males and females (HR 1.61 vs HR 1.83, p-interaction=0.19). ( Figure ) Conclusion: Hypertension may be a stronger risk factor for incident HF among blacks versus whites. This finding may be due to disparities in hypertension severity, control, or duration.

Prevalence and treatment of hypertension in China: impacts of 2017 American College of Cardiology/American Heart Association High Blood Pressure Guideline

The definition, recommended treatment thresholds and targets of hypertension have been updated in the recent 2017 American College of Cardiology/American Heart Association (ACC/AHA) Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults. However, the impacts of this guideline on Chinese population are currently unknown. In this study, we aim to provide updated data in China using criteria from the updated guideline. A multistage, stratified sampling method was used to obtain a representative sample of 50,171 adults aged 18 years and above. Hypertension was defined as an average systolic blood pressure ≥130 mm Hg, or an average diastolic blood pressure ≥80 mm Hg, or self-reported use of antihypertensive medications in past 2 weeks. The weighted prevalence of hypertension was 60.1% (95% confidence interval [CI] 59.3%–61.0%). The treatment rate and recommended treatment rate were 16.8% (95% CI 16.1%–17.6%) and 53.7% (95% CI 52.6%–54.9%), respectively; the gap was more prominent among men and participants from rural areas. Hence, the adoption of the 2017 ACC/AHA guideline will lead to a substantial increase in both prevalence and number of patients needing treatment in China. The applicability of this guideline should be carefully evaluated based on evidence from Chinese population.

Hypertension prevalence, awareness, treatment, and control in northeast China: a population-based cross-sectional survey.

Hypertension has been recognized as a major risk factor for cardiovascular disease. We aimed to analyze the current prevalence, awareness, treatment, and control of hypertension in northeast China. This cross-sectional survey adopted the multistage stratified random cluster sampling method to obtain a representative sample of adults aged 40 years or older in the general population of northeast China. Hypertension was defined as a systolic blood pressure (SBP) ≥ 140 mm Hg, or diastolic blood pressure (DBP) ≥ 90 mm Hg, or self-reported use of antihypertensive medications in the last 2 weeks irrespective of BP. Altogether 4052 participants were included with weighted prevalence of hypertension of 57.3%. Among them, 47.4% were aware of their condition; 78.8% took antihypertensive medication, but only 10.2% had their blood pressure controlled. Individuals who were overweight/obesity, with dyslipidemia, or diabetes were at a higher risk of hypertension; these people also more likely to be aware of their condition. Subjects with a personal history of stroke were more inclined to receive antihypertensive medication, but that did not necessarily translate to well-controlled hypertension. Moreover, dyslipidemia (OR = 0.600; 95% CI: 0.375, 0.960) were associated with poor hypertension control. Subjects using combination of antihypertensive medications (OR = 2.924; 95% CI: 1.606, 5.325) or with a family history of coronary heart disease were more likely to have their blood pressure controlled. Our study identified a high prevalence of hypertension in northeast China. Although awareness and treatment rates improved over the last decade, the control rate remained disproportionately and unacceptably low.

Abstract 21023: Population Attributable Risk for Cardiovascular Disease Associated With Hypertension and Prehypertension in African Americans: The Jackson Heart Study

Introduction: African Americans are disproportionately affected by hypertension (HTN) and cardiovascular disease (CVD). Determining the population attributable risk (PAR) for CVD associated with HTN and prehypertension in African Americans can help inform policymakers and prioritize public health interventions. Methods: Among 3770 participants in the Jackson Heart Study without prevalent CVD, we used Cox-proportional hazard analysis adjusted for traditional CVD risk factors to determine the association of HTN and prehypertension with incident CVD and its components including coronary heart disease, heart failure, and stroke. The PAR was calculated as pd*(HR-1)/HR; where pd is the prevalence of the exposure and HR is the hazard ratio for the outcome associated with the exposure. HTN was defined as a systolic blood pressure (SBP) ≥140 mmHg, diastolic blood pressure (DBP) ≥90 mmHg, or self-reported antihypertensive medication use and prehypertension as SBP of 120 to 139 mmHg or DBP of 80 to 89 mmHg. Results: At baseline, 52.4% of the cohort had HTN and 77.1% had prehypertension or HTN. Over a median of 9.9 years follow-up, 349 (9.3%) participants developed CVD. The HR for CVD and PAR associated with HTN was 2.17 (95% CI 1.63, 2.89) and 0.28 (95% CI 0.20, 0.35), respectively (Table). The HR for CVD and PAR associated with HTN and prehypertension pooled together was 2.21 (95% CI 1.41, 3.47) and 0.42 (95% CI 0.25, 0.56), respectively. In the pooled group there were significant associations with incident coronary heart disease, heart failure, and stroke. Sex-specific sensitivity analysis demonstrated PAR for CVD associated with HTN and prehypertension was 0.40 (95% CI 0.07, 0.62) in men and 0.43 (95% CI 0.19, 0.61) in women. Conclusions: Approximately 40% of incident CVD is attributable to HTN and prehypertension among African Americans in the southeastern United States. Preventing HTN and prehypertension in this population is a major public health priority.

Prevalence, awareness, treatment, and control of hypertension in China: data from 1·7 million adults in a population-based screening study (China PEACE Million Persons Project)

Hypertension is common in China and its prevalence is rising, yet it remains inadequately controlled. Few studies have the capacity to characterise the epidemiology and management of hypertension across many heterogeneous subgroups. We did a study of the prevalence, awareness, treatment, and control of hypertension in China and assessed their variations across many subpopulations. We made use of data generated in the China Patient-Centered Evaluative Assessment of Cardiac Events (PEACE) Million Persons Project from Sept 15, 2014, to June 20, 2017, a population-based screening project that enrolled around 1·7 million community-dwelling adults aged 35-75 years from all 31 provinces in mainland China. In this population, 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 in the previous 2 weeks. Hypertension awareness, treatment, and control were defined, respectively, among hypertensive adults as a self-reported diagnosis of hypertension, current use of antihypertensive medication, and blood pressure of less than 140/90 mm Hg. We assessed awareness, treatment, and control in 264 475 population subgroups-defined a priori by all possible combinations of 11 demographic and clinical factors (age [35-44, 45-54, 55-64, and 65-75 years], sex [men and women], geographical region [western, central, and eastern China], urbanity [urban vs rural], ethnic origin [Han and non-Han], occupation [farmer and non-farmer], annual household income [< ¥10 000, ¥10 000-50 000, and ≥¥50 000], education [primary school and below, middle school, high school, and college and above], previous cardiovascular events [yes or no], current smoker [yes or no], and diabetes [yes or no]), and their associations with individual and primary health-care site characteristics, using mixed models. The sample contained 1 738 886 participants with a mean age of 55·6 years (SD 9·7), 59·5% of whom were women. 44·7% (95% CI 44·6-44·8) of the sample had hypertension, of whom 44·7% (44·6-44·8) were aware of their diagnosis, 30·1% (30·0-30·2) were taking prescribed antihypertensive medications, and 7·2% (7·1-7·2) had achieved control. The age-standardised and sex-standardised rates of hypertension prevalence, awareness, treatment, and control were 37·2% (37·1-37·3), 36·0% (35·8-36·2), 22·9% (22·7-23·0), and 5·7% (5·6-5·7), respectively. The most commonly used medication class was calcium-channel blockers (55·2%, 55·0-55·4). Among individuals whose hypertension was treated but not controlled, 81·5% (81·3-81·6) were using only one medication. The proportion of participants who were aware of their hypertension and were receiving treatment varied significantly across subpopulations; lower likelihoods of awareness and treatment were associated with male sex, younger age, lower income, and an absence of previous cardiovascular events, diabetes, obesity, or alcohol use (all p<0·01). By contrast, control rate was universally low across all subgroups (<30·0%). Among Chinese adults aged 35-75 years, nearly half have hypertension, fewer than a third are being treated, and fewer than one in twelve are in control of their blood pressure. The low number of people in control is ubiquitous in all subgroups of the Chinese population and warrants broad-based, global strategy, such as greater efforts in prevention, as well as better screening and more effective and affordable treatment. Ministry of Finance and National Health and Family Planning Commission, China.

Influence of Child and Adult Elevated Blood Pressure on Adult Arterial Stiffness: The Cardiovascular Risk in Young Finns Study.

Elevated blood pressure (BP) in childhood has been associated with increased adult arterial stiffness, the independent predictor of cardiovascular and all-cause mortality. The favorable BP change from childhood to adulthood and the risk of high adult arterial stiffness has not been reported. We examined the effect of child and adult BP on pulse wave velocity (PWV) assessed in adulthood among 1540 white adults followed-up for 27 years since baseline (1980, aged 6-18 years). Childhood elevated BP was defined according to the tables from the National High Blood Pressure Education Program. In adulthood, BP was classified as elevated if systolic BP ≥120 mm Hg, diastolic BP ≥80 mm Hg, or self-reported use of antihypertensive medications. PWV was measured in 2007 by whole-body impedance cardiography, and high PWV was defined as values at or above the age-, sex-, and heart rate-specific 80th percentile. Individuals with persistently elevated BP and individuals with normal child but elevated adult BP had increased risk of high adult PWV (relative risk [95% confidence interval], 3.18 [2.22-4.55] and 2.64 [1.79-3.88], respectively) in comparison with individuals with normal (both child and adult) BP. In contrast, individuals with elevated BP in childhood but not in adulthood did not have significantly increased risk of high PWV (relative risk [95% confidence interval], 1.26[0.80-1.99]). The results were consistent when different definitions for child and adult elevated BP were applied. These findings highlight the importance of BP control in the primary prevention of cardiovascular diseases.

Recruitment Strategies and Costs Associated With Enrolling People With Insomnia and High Blood Pressure Into an Online Behavioral Sleep Intervention: A Single-Site Pilot Study.

Recruitment in clinical research is a common challenge and source of study failure. The reporting of recruitment methods and costs in hypertension trials is limited especially for smaller, single-site trials, online intervention trials, and trials using newer online recruitment strategies. The aims of this study are to describe and examine the feasibility of newer online-e-mail recruitment strategies and traditional recruitment strategies used to enroll participants with insomnia and high blood pressure into an online behavioral sleep intervention study (Sleeping for Heart Health). The 16 online-e-mail-based and traditional recruitment strategies used are described. Recruitment strategy feasibility was examined by study interest and enrollee yields, conversion rates, and costs (direct, remuneration, labor, and cost per enrollee). From August 2014 to October 2015, 183 people were screened and 58 (31.7%) enrolled in the study (51.1 ± 12.9 years, 63.8% female, 72.4% African American, 136 ± 12/88 ± 7 mm Hg, 87.9% self-reported hypertension, 67.2% self-reported antihypertensive medication use). The recruitment strategies yielding the highest enrollees were the university hospital phone waiting message system (25.4%), Craigslist (22.4%), and flyers (20.3%) at a per enrollee cost of $42.84, $98.90, and $128.27, respectively. The university hospital phone waiting message system (55.6%) and flyers (54.5%) had the highest interested participant to enrolled participant conversion rate of all recruitment strategies. Approximately 70% of all enrolled participants were recruited from the university hospital phone waiting message system, Craigslist, or flyers. Given the recruitment challenges that most researchers face, we encourage the documenting, assessing, and reporting of detailed recruitment strategies and associated recruitment costs so that other researchers may benefit.