October 23, 2019
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Hypertension significant cause of CVD events in black adults

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Donald Clark III

Black adults younger than 60 years were found to have elevated population-attributable risk for CVD, CHD, HF and stroke associated with hypertension, according to findings published in JAMA Cardiology.

In a multivariable-adjusted analysis, researchers found that among black adults, hypertension conferred a significantly elevated risk for CVD (HR = 1.91; 95% CI, 1.48-2.46), CHD (HR = 2.41; 95% CI, 1.59-3.66), HF (HR = 1.52; 95% CI, 1.01-2.3) and stroke (HR = 2.2; 95% CI, 1.44-3.36). The population-attributable risk (PAR) for these outcomes was significantly higher in black adults younger than 60 years (PAR = 54.6%; 95% CI, 37.2-68.7) compared with those aged 60 years or older (PAR = 32%; 95% CI, 11.9-48.1).

These findings led researchers to conclude that 32.5% of CVD events in black adults were associated with hypertension, according to the study.

“This represents one of the largest studies to evaluate the population impact of hypertension on cardiovascular disease in black adults in the U.S.,” Donald Clark III, MD, MPH, assistant professor of medicine at the University of Mississippi Medical Center, Jackson, told Healio. “Our findings demonstrate that nearly 1 in 3 cardiovascular events are associated with hypertension in this population. Further work is needed to evaluate strategies to reduce blood pressure at a population level.”

In other findings, the researchers reported the PAR associated with hypertension was 32.5% for CVD (95% CI, 20.5-43.6), 42.7% for CHD (95% CI, 24-58.4), 21.6% for HF (95% CI, 0.6-40.8) and 38.9% for stroke (95% CI, 19.4-55.6).

“The prevalence of hypertension and hypertension-related cardiovascular disease are higher among black adults compared to other racial/ethnic groups,” Clark said. “While this study did not directly address risk factors for developing hypertension, it has been shown that interventions such as regular physical activity, weight control and a heart-healthy diet prevent the development of hypertension.”

Black adults younger than 60 years were found to have elevated population-attributable risk for CVD, CHD, HF and stroke associated with hypertension, according to findings published in JAMA Cardiology.
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In this prospective cohort study of 12,497 black adults older than 21 years, with no CVD at baseline (1,935 with normal BP; 33% men; mean age, 54 years; 929 with elevated BP; 41% men; mean age, 59 years; 9,633 with hypertension; 36% men; mean age, 62 years), researchers aimed to determine the PAR for CVD events associated with hypertension.

“The impact of hypertension on cardiovascular disease among black adults is significant, although our findings are largely consistent with smaller prior studies,” Clark said. “Perhaps most striking is the population-attributable risk of 69% for stroke associated with hypertension among those younger than 60 years. These findings highlight the importance of preventing and treating hypertension among younger adults to reduce the burden of cardiovascular disease, primarily stroke.”

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With participant data from enrollees in the Jackson Heart Study from Sept. 26, 2000, to March 2004 and REGARDS study from July 2003 to Sept. 12, 2007, researchers used the National Health and Nutrition Examination Survey 2011-2014 data to estimate the prevalence of hypertension in non-Hispanic black individuals.

“This study has limitations. For risk factors with a high prevalence, such as hypertension, PAR estimates may be less precise and therefore should be interpreted with caution. We relied on BP from a single visit, and current guidelines recommend that the classification of BP be based on two or more BP measurements at two or more visits,” the researchers wrote.

“Hypertension is a major public health issue, and this study supports the need to prioritize resources for this condition,” Clark told Healio. “Our study supports further investigation and evaluation of policies to reduce blood pressure at a population level, such as public health interventions to increase physical activity, reduce dietary sodium intake and ensure access to effective diagnosis and treatment.” – by Scott Buzby

Disclosures: Clark reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.