Deborah Rohm Young
Patients who were African-American, Asian, American Indian/Alaska Native, or Native Hawaiian and other Pacific Islanders had an increased risk for hypertension compared with those who were white or Hispanic regardless of weight category, neighborhood status or education level, according to a study published in the Journal of Clinical Hypertension.
“[The study] does document how highly prevalent hypertension is across all race/ethnicities, with Hispanics having the lowest prevalence, and even statistically significantly lower than whites overall and across weight and neighborhood education categories,” Deborah Rohm Young, PhD, director of behavioral research in the department of research and evaluation at Kaiser Permanente Southern California in Pasadena, said in an interview.
Overweight, obese adults
Researchers analyzed data from 4,060,585 patients older than 18 years with obesity or overweight. Patients identified themselves as black or African-American (11.4%), Asian (13.1%), Hispanic (24.8%), Native Hawaiian or other Pacific Islander (1.5%), white (48.6%) or American Indian/Alaska Native (0.6%).
Patients of all races/ethnicities except Asians had a BMI of at least 25 kg/m2, which was confirmed through their electronic health records. Asian patients had a BMI of at least 23 kg/m2. All patients except Asian patients were categorized as overweight if BMI were 25 kg/m2 to 29.9 kg/m2, obese class 1 if BMI were 30 kg/m2 to 34.9 kg/m2, obese class 2 if BMI were 35 kg/m2 to 39.9 kg/m2 and obese class 3 if BMI were greater than 40 kg/m2). Asian patients were categorized as overweight if they were 23 kg/m2 to 27.4 kg/m2, obesity class 1 if they were 27.5 kg/m2 to 32.4 kg/m2, obesity class 2 if they were 32.5 kg/m2 to 37.4 kg/m2 and obesity class 3 if they were greater than 37.5 kg/m2.
Hypertension was defined as one inpatient hospitalization with a coded diagnosis of hypertension or at least two outpatient visits with a diagnosis of hypertension.
Geocoding was performed to estimate neighborhood education.
Hypertension was diagnosed in 36.9% of patients.
Increased risk for hypertension
ORs for the prevalence of hypertension were greater in American Indian/Alaska Native patients (OR = 1.17; 95% CI, 1.13-1.2), black patients (OR = 2.02; 95% CI, 2-2.03), Asian patients (OR = 1.42; 95% CI, 1.41-1.43) and Native Hawaiian or other Pacific Islander patients (OR = 1.85; 95% CI, 1.81-1.9) compared with white patients in similar weight categories and neighborhood education levels. Hispanic patients were less likely to have hypertension (OR = 0.96; 95% CI, 0.95-0.97) compared with white patients.
Across races and ethnicities, the odds for developing hypertension did not substantially vary across neighborhood education and weight, although two-way interactions were statistically significant for both categories (P < .0001).
Compared with white patients, the odds of developing hypertension were doubled for black patients, 20% greater for American Indian/Alaska Native patients and between 36% and 46% greater for Asian patients at all neighborhood education levels.
“It would be interesting to learn if these disparities remain when controlling for body composition,” Young told Cardiology Today. “The amount of body fat and where fat is deposited differs by race/ethnicity, and we were not able to examine this. It would also be important to learn if there are Hispanic or Asian subgroups at greater or lesser risk of hypertension prevalence. Finally, how neighborhood conditions may vary by education status and by the dominant culture may also be informational. Does a low-education neighborhood with a high number Asian residents have different characteristics from a low-education neighborhood with a high number of Hispanic residents, for example.” – by Darlene Dobkowski
The authors report no relevant financial disclosures.