Self-reported Antihypertensive Medication Use Research Articles

Prevalence, awareness, treatment, and control of hypertension in community-dwelling older adults with chronic kidney disease: the Irish longitudinal study on ageing.

Hypertension is highly prevalent in chronic kidney disease (CKD), posing a significant but modifiable risk for adverse clinical outcomes. This study explored the prevalence, awareness, treatment, and control of hypertension in older Irish adults with CKD. Data were analysed from participants in Wave 1 of The Irish Longitudinal Study on Ageing (TILDA) who were aged 50 years and older. CKD was defined as eGFR <60ml/min/1.72 m2, hypertension defined as systolic blood pressure (SBP) ≥140mmHg and/or diastolic blood pressure (DBP) ≥90mmHg and/or self-reported use of antihypertensive medication. Participant awareness and treatment of hypertension was based on self-report and SBP/DBP <140/90mmHg. Multivariable logistic regression examined relationships with awareness, treatment, and control of hypertension expressed as adjusted odds ratios. Prevalence of hypertension was significantly higher in participants with CKD than without (81.9%vs 59.7%, P<.001). Among hypertensive individuals, 70.1% (95% CI: 65.8-74.1) were aware, 83.5% (95% CI 80.0-86.6) were on treatment, yet blood pressure control <140/90mmHg and SBP <120mmHg were achieved in only 49.3% (CI 44.0-54.7%) and 17.9% (CI 14.4-22.1), respectively. In multivariable analysis, advancing age 1.05 (CI 1.01-1.10), obesity 6.23 (CI 2.51-15.5), diabetes 5.78 (CI 1.55-21.5), and cardiovascular disease 9.89 (CI 3.27-29.9) were associated with higher odds of treatment, while cardiovascular disease 2.35 (CI 1.39-3.99) and combination antihypertensive therapy 1.76 (CI 1.03-3.01) were associated with blood pressure control. The prevalence of hypertension is substantial in older Irish adults with CKD; however, control is poor. Approximately, one-third of participants were unaware of their hypertensive status and approximately one-fifth were untreated.

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.

Trends of mean systolic and diastolic blood pressure among adults in Shenzhen, China, 1997–2018: findings from three rounds of the population-based survey

ObjectiveTo quantify the trends in systolic and diastolic blood pressure (BP) among adults in Shenzhen from 1997 to 2018.DesignCross-sectional study.SettingsThe data were collected from all districts in Shenzhen, China in...

Life's Essential 8 and Incident Hypertension Among US Hispanic/Latino Adults: Results From the Hispanic Community Health Study/Study of Latinos.

Life's Essential 8 (LE8) is a new metric to define cardiovascular health. We aimed to describe LE8 among Hispanics/Latinos and its association with incident hypertension. The HCHS/SOL (Hispanic Community Health Study/Study of Latinos) is a study of Hispanic/Latino adults aged 18 to 74 years from 4 US communities. At visit 1 (2008-2011), information on behavioral and clinical factors (diet, smoking status, physical activity, sleep duration, body mass index, blood pressure, cholesterol, fasting glucose, and medication use) were measured and used to estimate an LE8 score (range, 0-100) for 14 772 participants. Hypertension was defined as systolic blood pressure ≥130 mm Hg or diastolic blood pressure ≥80 mm Hg, or self-reported use of antihypertensive medications. Among the 5667 participants free from hypertension at visit 1, we used Poisson regression models to determine the multivariable adjusted association between LE8 and incident hypertension in 2014 to 2017. All analyses accounted for the complex survey design of the study. Mean population age was 41 years, and 21.6% (SE, 0.7) had high cardiovascular health (LE8 ≥80). Mean LE8 score (68.2; SE, 0.3) varied by Hispanic/Latino background (P<0.05), ranging from 72.6 (SE, 0.3) among Mexican Americans to 62.2 (SE, 0.4) among Puerto Ricans. Each 10-unit decrement in LE8 score was associated with a 22% increased risk of hypertension over ≈6 years (incident density ratio, 1.22 [95% CI, 1.16-1.29]). Only 1 in 5 Hispanic/Latino adults had high cardiovascular health, and LE8 varied substantially across Hispanic/Latino background groups. Improvements in other components of cardiovascular health may result in a lower risk of developing hypertension.

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

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

Initiation of Antihypertensive Medication from Midlife on Incident Dementia: The Health and Retirement Study.

Hypertension has been identified as a risk factor of dementia, but most randomized trials did not show efficacy in reducing the risk of dementia. Midlife hypertension may be a target for intervention, but it is infeasible to conduct a trial initiating antihypertensive medication from midlife till dementia occurs late life. We aimed to emulate a target trial to estimate the effectiveness of initiating antihypertensive medication from midlife on reducing incident dementia using observational data. The Health and Retirement Study from 1996 to 2018 was used to emulate a target trial among non-institutional dementia-free subjects aged 45 to 65 years. Dementia status was determined using algorithm based on cognitive tests. Individuals were assigned to initiating antihypertensive medication or not, based on the self-reported use of antihypertensive medication at baseline in 1996. Observational analog of intention-to-treat and per-protocol effects were conducted. Pooled logistic regression models with inverse-probability of treatment and censoring weighting using logistic regression models were applied, and risk ratios (RRs) were calculated, with 200 bootstrapping conducted for the 95% confidence intervals (CIs). A total of 2,375 subjects were included in the analysis. After 22 years of follow-up, initiating antihypertensive medication reduced incident dementia by 22% (RR = 0.78, 95% CI: 0.63, 0.99). No significant reduction of incident dementia was observed with sustained use of antihypertensive medication. Initiating antihypertensive medication from midlife may be beneficial for reducing incident dementia in late life. Future studies are warranted to estimate the effectiveness using large samples with improved clinical measurements.

#6749 PREVALENCE, AWARENESS, TREATMENT, AND CONTROL OF HYPERTENSION IN OLDER ADULTS WITH CHRONIC KIDNEY DISEASE: THE IRISH LONGITUDINAL STUDY ON AGEING

Abstract Background and Aims Hypertension is a well-known modifiable risk factor for chronic kidney disease (CKD) yet effective management remains a challenge. Data on hypertension awareness, treatment and control among CKD patients in Ireland is limited. Therefore, the objective of this study was to determine the prevalence, extent of awareness, treatment and control of hypertension among older adults with CKD in the Irish population. Method We utilised cross sectional data from the first wave of The Irish Longitudinal Study on Ageing (TILDA) conducted between 2009 and 2011. Participants aged 50 years or more with complete measurements on serum creatinine and blood pressure (BP) were included (n = 5, 356). CKD was defined as eGFR &amp;lt;60ml/min/1.72m2. Hypertension was defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg and/or self-reported use of antihypertensive medication. Participants’ awareness and treatment of hypertension were defined using self-report and hypertension control was evaluated as systolic/diastolic blood pressure &amp;lt;140/90 mmHg. We determined the weighted prevalence of hypertension, awareness, treatment, and control using sample weights, and multivariable logistic regression explored associations of demographic, clinical and behavioural characteristics with control of hypertension. Associations were expressed using adjusted odds ratios (OR) with 95% confidence intervals (CIs). Analyses were conducted in Stata and R. Results There were 639/5,356 participants [13.3% (95%CI: 12.3-14.4)] with CKD. The weighted prevalence of hypertension was significantly higher in participants with CKD than without CKD (81.8% versus 59.8% respectively, P&amp;lt;0.001). Among those with CKD and hypertension, 70.8% (95% CI: 66.5-74.7) were aware of hypertension, and 83.4% (95% CI 79.9-86.5) were treated with antihypertensive medication. Despite higher levels of awareness and treatment of hypertension in those with CKD, only 50.4% (95% CI 45.4-55.5) of treated subjects had BP &amp;lt;140/90 mmHg. BP control was similarly poor for non-CKD participants at 49.4% (95%CI: 46.9-51.8). The most commonly used medications among treated CKD participants were β-blockers 41.8% (95% CI 36.7-47.1), angiotensin-converting enzyme inhibitors 34.0% (95% CI 29.2-39.2), and angiotensin receptor blockers 33.7% (95% CI: 28.9-38.8). Over half [54.8% (95% CI: 49.5-60.0)] of CKD participants were treated with ≥ 2 antihypertensive medications. In multivariable analysis, the likelihood of BP control (&amp;lt;140/90 mmHg) was lower for older CKD patients [OR: 0.94 (95% CI: 0.90-0.98) per 1 year increase in age], greater for those on combination therapy [OR: 1.87 (95%CI: 1.13-3.1)] and for those with history of cardiovascular disease [OR: 2.33 (95%CI: 1.43-3.82)]. Conclusion Despite established evidence that control of hypertension can slow the progression of CKD and reduce cardiovascular complications, our results indicate that the prevalence of hypertension in older adults with CKD is high and the control of hypertension is poor and worsens with advancing age. Approximately, one third of participants with CKD were unaware of their hypertensive status and approximately one fifth of participants were untreated.

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.

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.

Hypertension severity, apparent treatment resistant hypertension and hyperuricemia in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study.

Prior studies have identified an association between hypertension and hyperuricemia; however, there has been limited research on the association between hypertension severity and hyperuricemia. We studied 997 Black and white adults with serum urate data from the reasons for geographic and racial differences in stroke (REGARDS) study. Hypertension was defined as SBP ≥ 140 mmHg or DBP ≥ 90 mmHg or self-reported use of antihypertensive medication. Apparent treatment-resistant hypertension (aTRH) was defined as a SBP ≥ 140 mmHg or DBP ≥ 90 mmHg with concurrent use of three classes of antihypertensive medications, or taking four or more classes of antihypertensive medication regardless of BP level. Controlled BP was defined as SBP <140 mmHg and DBP <90 mmHg. Overall 5.9% of participants had aTRH and 36.6% had hyperuricemia, defined as serum urate >7.0 mg/dl for men and >6.0 mg/dl for women. After full multivariable adjustment, the odds ratio (OR) for hyperuricemia associated with hypertension was 1.60 [95% confidence interval (95% CI): 1.06-2.40]. Compared to participants not taking antihypertensive medication, the ORs for hyperuricemia for participants taking one, two and three classes of antihypertensive medication without aTRH were 1.98 (95% CI: 1.23-3.20), 2.08 (95% CI: 1.25-3.43), 4.31 (95% CI: 2.07-8.97), respectively, and 3.96 (95% CI: 1.75-8.96) for aTRH. Compared to participants without hypertension, the odds ratios for hyperuricemia were 1.67 (95% CI: 1.08-2.58) and 1.46 (95% CI: 0.88-2.44) among those with hypertension with and without controlled BP, respectively. Diuretic use was associated with a higher odds of hyperuricemia. This study suggests that individuals taking more classes of antihypertensive medication may benefit from monitoring for hyperuricemia.

Abstract P393: AHA Life’s Essential 8 and Incident Hypertension Among US Hispanics/Latinos: Results From the Hispanic Community Health Study/Study of Latinos

Background: The American Heart Association’s Life Essential 8 (LE8) are a set of eight simple health metrics used to define cardiovascular (CV) health and promote healthy behaviors. Our objectives are to: 1) describe for the first time, LE8 among Hispanics/Latinos of diverse backgrounds and 2) determine the association between LE8 and incident hypertension, a leading risk factor for CV disease. Methods: The Hispanic Community Health Study/Study of Latinos is a population-based study of diverse Hispanics/Latinos aged 18-74 years from four US communities. Participants were examined in 2008-2011 (visit 1) and 2014-2017 (visit 2). At visit 1, information on behavioral factors (diet, smoking status, physical activity, sleep duration) and clinical factors (BMI, blood pressure, cholesterol, fasting glucose, and medication use) were measured and used to estimate a LE8 score (range: 0 to 100%) for 14,772 participants with complete information. Ideal cardiovascular health (ICH) was defined by LE8 ≥ 80%. Hypertension was defined as systolic BP ≥130 mmHg or diastolic BP ≥80 mmHg, or self-reported use of antihypertensive medications. We estimated ICH and described LE8 score according to Hispanic/Latino background group. Among the 5,667 participants free from hypertension at visit 1, we used Poisson regression models to determine the association between LE8 and incident hypertension at visit 2 including time between visits as an offset. Models were adjusted for age, sex, Hispanic/Latino background, income, education, nativity, health insurance, and marital status. All analyses accounted for the complex survey design of the study. Results: Among diverse US Hispanics/Latinos with a mean age of 41, 21.6% (SE: 0.7) had ICH. Mean LE8 score (68.2, SE: 0.3) varied by Hispanic/Latino background (p&lt;0.05). Compared with Mexican background, (mean: 72.6, SE: 0.3), LE8 was significantly lower (less favorable) in all other Hispanic/Latino background groups: mean score of 62.2 (SE: 0.4) among Puerto Ricans; 62.3 (SE: 0.5) among Cubans; 69.3 (SE: 0.4) among Central Americans, 70.2 (SE: 0.5) among Dominicans; and 70.2 (SE: 0.7) among South Americans. Among Hispanics/Latinos without hypertension at Visit 1, each 10% decrement in LE8 score was associated with 23% increased risk of hypertension over approximately six years (incident density ratio: 1.23, 95% CI: 1.16, 1.30). Conclusion: Only one in five Hispanics/Latinos had ICH and LE8 varied substantially across Hispanic/Latino background group. Improvements in other components of CV health may result in lower risk of developing hypertension.

Abstract P347: Rural/urban Differences In Anti-hypertensive Medication Use Among Women Of Reproductive Age With Hypertension: Behavioral Risk Factor Surveillance System, 2019

Introduction: Hypertension is a leading risk factor for cardiovascular disease in the US. Approximately one in ten to one in six women of reproductive age (WRA; aged 18-44 years) have hypertension. Control of hypertension through lifestyle behaviors and anti-hypertensive medication can prevent complications across the life course. Characterizing the current use of anti-hypertensive medication among WRA by urban/rural status offers opportunities to inform public health action. Methods: Data from 59,407 WRA responding to the 2019 Behavioral Risk Factor Surveillance System was used to determine hypertension prevalence from 49 states (New Jersey did not meet data collection standards), District of Columbia, Guam, and Puerto Rico. Among the subset of 6,855 who self-reported hypertension, estimates of current anti-hypertensive medication use were calculated. Prevalence ratios were used to estimate the association between urban/rural status and self-reported use of anti-hypertensive medications, adjusting for age, race/ethnicity, education, and insurance status. Results: The estimated hypertension prevalence among WRA was 10.7% (95%CI:10.3%-11.1%) with 14.0% (95%CI:12.7%-15.5%) in rural and 10.4% (95%CI:10.0%-10.9%) in urban counties. An estimated 45.1% (95%CI:43.1%-47.2%) of WRA with hypertension reported currently using anti-hypertensive medication with estimates of 57.1% (95%CI:51.9%-62.1%) in rural and 44.0% (95%CI:41.9%-46.2%) in urban counties. WRA with hypertension living in rural counties were 1.29 times (95%CI:1.17-1.41) more likely to report currently using anti-hypertensive medication compared to those living in urban counties. Conclusion: Less than half of WRA with hypertension were currently using anti-hypertensive medication. Living in rural counties was associated with a higher frequency of use of anti-hypertensive medication. Ensuring appropriate blood pressure control through engagement in healthy lifestyle behaviors and appropriate use of medication when needed in WRA can improve cardiovascular health and reduce disparities.

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; &gt;0.06 pg/mL) or cytokine tertiles (tertile thresholds [33 rd &amp; 66 th %iles] in pg/mL: IL-6, 0.56 &amp; 0.94; TNF-α, 1.30 &amp; 1.69; IFN-γ, 4.01 &amp; 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.

Prevalence and control of hypertension among people living with HIV receiving care at a Nigerian hospital

Introductionwith the introduction of newer and safer antiretroviral drugs, HIV positive persons are now living longer. Consequently, cardiovascular diseases associated with ageing and chronic low grade inflammation due to the presence of the virus are increasingly found in this population. This study aimed to assess the prevalence and control of hypertension among people living with HIV (PLHIV) receiving care at a Nigerian hospital.Methodsthis cross-sectional study was conducted as part of the Patient´s HIV Knowledge Questionnaire (PHKQ) validation study among HIV positive outpatients at the University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria. Hypertension was self-reported and confirmed by a documented physician diagnosis in the patient´s case notes and/or self-reported use of antihypertensive medication. For each participant, the average of two close blood pressure (BP) measurements obtained using an automatic upper arm BP monitor was taken as the BP. Hypertension control was defined as SBP <140 mmHg and DBP <90 mmHg. Data were analysed using the Statistical Product and Service Solutions (SPSS) v.21.0. Results were considered significant at p < 0.05.Resultsprevalence of hypertension among PLHIV was 24.9%. Age (OR = 1.112, CI = 1.074 – 1.151, p < 0.001), body mass index (OR = 1.087, CI = 1.024 – 1.154, p = 0.004) and duration on antiretroviral therapy (OR = 1.169, CI = 1.090 – 1.254, p < 0.001) significantly predicted hypertension. Only 19 (24.4%) participants had controlled hypertension.Conclusionhypertension is common among PLHIV seeking care at a Nigerian hospital. However, its control remains suboptimal. Regular screening for hypertension, its appropriate treatment and optimal control are essential in PLHIV.

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.

Epidemiological features of hypertension among ischemic survivors in Northeast China: insights from a population-based study, 2017\u20132019

BackgroundHypertension remains the major modifiable risk factor of stroke recurrence. The study aimed to determine the up-to-date epidemiological features of hypertension among the survivors of ischemic stroke.MethodsOur cross-sectional study included 18,796 adults aged ≥40 years and residing in northeast China. Ischemic stroke was diagnosed according to the World Health Organization’s criteria, which requires the clinical record, computed tomography (CT) and/or magnetic resonance imaging (MRI) during the hospital stay. Hypertension was defined according to the Chinese hypertension guidelines (mean SBP ≥140 mmHg and/or mean DBP ≥90 mmHg, and/or self-reported use of anti-hypertensive medication in the past 2 weeks).ResultsOf the 986 survivors of ischemic stroke, 819 (83.1%) were identified with hypertension (535 were pre-stroke hypertension and 284 were post-stroke hypertension). Among hypertensive patients, the awareness and treatment rates were 76.8 and 66.7% respectively. Only 11.0% achieved an appropriate blood pressure (< 140 mmHg and < 90 mmHg) among those who took hypertensive medications. 16.8% of treated hypertensive patients received combination therapy, and calcium channel blockers were the most frequently used anti-hypertensive medication as monotherapy. The mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) of the stroke population was 155.3 ± 22.9 mmHg and 89.2 ± 12.3 mmHg. Both SBP and DBP were higher in rural patients than in urban patients (158.5 ± 23.8 mmHg vs. 146.4 ± 17.5 mmHg and 90.3 ± 12.9 mmHg vs. 85.9 ± 10.1 mmHg, respectively; p < 0.001). The rates of stage 2 and above hypertension in the ischemic stroke population were 32.5 and 18.7%, and was significantly higher in rural areas than in urban areas.ConclusionsThe prevalence of poorly-controlled hypertension and the high rates of blood pressures at stages 2 and above in patients with prior ischemic stroke demonstrated an alarming situation in northeast China.

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.

TRENDS IN STATUS OF HYPERTENSION IN SOUTH CHINA: RESULTS FROM TWO REPRESENTATIVE CROSS-SECTIONAL SURVEYS, 2012-2017

Abstract Objective: This study aims to investigate the long-term natural trends in the status of hypertension in south China from 2012–2017. Design and method: Two successive cross-sectional surveys were conducted in Guangdong Province in 2012 and 2017, which include 10970 and 36376 participants aged 35 to 75 from different area, respectively. A multistage, stratified and cluster random sampling method was used to enroll the participants. Hypertension was defined as a mean systolic blood pressure at least 140mmHg and/or a mean diastolic blood pressure at least 90 mmHg, and/or self-reported use of antihypertensive medication within past 2 weeks, according to the 2010 Chinese guidelines for the management of Hypertension. The prevalence and control rates of hypertension were also estimated according to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) high blood pressure guideline. Results: In 2012, 39.3% participants had hypertension, whereas 37.6% participants had hypertension in 2017. The age-standardized prevalence was 34.7% [95% confidence interval (CI): 34.1–35.2] and 31.9% (95% CI: 31.6–32.2) in 2012 and 2017, respectively. The prevalence of prehypertension decreased from 14.5 to 13.1% from 2012 to 2017. Over the two study periods, 45.6 and 51.2% of those with hypertension were aware of their diagnosis in 2012 and 2017, respectively, and 40.8 and 44.9% were taking antihypertensive medications, respectively; the control rates increase from 15.1 to 17.0% and among those who received medical treatment 36.9 and 37.9% achieved control of BP, respectively. Based on the 2017 ACC/AHA guideline, prevalence of hypertension was 64.5% in 2012 and 59.1% in 2017. The control rate increased from 3.0 to 4.4% during this period. And among participants who received medical treatment, only 12.2 and 15.2% of participants achieve the target of hypertensive management in 2012 and 2017, respectively. Conclusions: During 2012 to 2017, the prevalence of hypertension in South China trended to be stable, and the rate of awareness, treatment and control increased but still low.