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Blood Pressure and Glycemic Control Among Ambulatory US Adults With Heart Failure: National Health and Nutrition

Leah Rethy1, Thanh-Huyen T Vu2, Nilay S Shah2,3

  • 1Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.R.).

Circulation. Heart Failure
|April 28, 2022
PubMed

Insights

High rates of uncontrolled blood pressure (BP) and hemoglobin A1c (HbA1c) persist in ambulatory heart failure (HF) patients. Non-Hispanic Black individuals experience greater BP control disparities, highlighting a critical need for targeted interventions.

Area of Science:

  • Cardiology
  • Public Health
  • Health Disparities

Background:

  • Multisociety guidelines advocate for systolic blood pressure (BP) <130 mm Hg and hemoglobin A1c (HbA1c) <8% in heart failure (HF) patients.
  • Limited data exist on BP and glycemic control, and associated racial/ethnic disparities, in ambulatory HF populations.

Purpose of the Study:

  • To assess the prevalence of uncontrolled BP and HbA1c in ambulatory adults with HF.
  • To examine racial and ethnic disparities in BP and HbA1c control among these patients.
  • To analyze trends in uncontrolled BP and HbA1c over time.

Main Methods:

  • Analysis of National Health and Nutrition Examination Surveys (2001-2018) data for adults (≥20 years) with self-reported HF.
  • Calculation of prevalence ratios for uncontrolled BP and HbA1c by race/ethnicity (non-Hispanic Black, non-Hispanic White, Mexican American).
  • Adjustment for covariates including sex, age, treatment, and socioeconomic status; secondary analysis of trends.

Main Results:

  • 48% of adults with HF had uncontrolled BP, representing 2.3 million individuals.
  • Non-Hispanic Black participants showed a higher prevalence of uncontrolled BP (53%) compared to non-Hispanic White participants (47%), with adjusted models showing a 1.19 times higher likelihood.
  • Uncontrolled HbA1c was found in 8% overall, with no significant racial/ethnic differences. BP control improved over time, but remained high.
  • 2017-2018 data showed 41% uncontrolled BP and 7% uncontrolled HbA1c.

Conclusions:

  • A high prevalence of uncontrolled BP and HbA1c exists in a national sample of ambulatory HF patients.
  • Significant racial and ethnic disparities in BP control were observed, particularly affecting non-Hispanic Black individuals.
  • These findings underscore the need for improved management strategies to address uncontrolled risk factors and reduce health disparities in HF care.
Abstract

Keywords:
blood pressureepidemiologyheart failureprevalencerisk factors

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