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Prevalence, risk factors, and cardiovascular disease outcomes associated with persistent blood pressure control: The
Gabriel S Tajeu1, Calvin L Colvin2, Shakia T Hardy2
1Department of Health Services Administration and Policy, Temple University, Philadelphia, PA, United States of America.
Insights
Maintaining blood pressure control is crucial for reducing cardiovascular disease risk. Less than half of participants in the Jackson Heart Study achieved persistent blood pressure control, increasing heart failure risk.
Area of Science:
- Cardiology
- Public Health
- Hypertension Research
Background:
- Persistent blood pressure (BP) control is vital for reducing cardiovascular disease (CVD) risk in patients on antihypertensive medication.
- The Jackson Heart Study (JHS) investigates BP control in African American adults.
Purpose of the Study:
- To determine the proportion of African Americans with persistent BP control.
- To identify factors associated with sustained BP control.
- To assess the association between persistent BP control and CVD events.
Main Methods:
- Analysis of 1,604 JHS participants on antihypertensive medication with BP data from 2000-2013.
- Persistent BP control defined as systolic BP <140 mm Hg and diastolic BP <90 mm Hg across three visits.
- CVD events assessed through December 2016; hazard ratios adjusted for multiple factors.
Main Results:
- 76.4% had controlled BP at Visit 1; overall persistent BP control was 48.9%.
- Factors associated with persistent BP control included younger age (<65), female sex, consistent income (≥$25,000), and regular healthcare visits.
- Adjusted HR for persistent BP control was 0.71 for CVD, 0.68 for coronary heart disease, 0.65 for stroke, and 0.55 for heart failure.
Conclusions:
- Less than half of JHS participants on antihypertensive medication achieved persistent BP control.
- Inadequate persistent BP control is linked to an increased risk of heart failure.
Background:
Maintaining blood pressure (BP) control over time may contribute to lower risk for cardiovascular disease (CVD) among individuals who are taking antihypertensive medication.
Methods:
The Jackson Heart Study (JHS) enrolled 5,306 African-American adults ≥21 years of age and was used to determine the proportion of African Americans that maintain persistent BP control, identify factors associated with persistent BP control, and determine the association of persistent BP control with CVD events. This analysis included 1,604 participants who were taking antihypertensive medication at Visit 1 and had BP data at Visits 1 (2000-2004), 2 (2005-2008), and 3 (2009-2013). Persistent BP control was defined as systolic BP <140 mm Hg and diastolic BP <90 mm Hg at all three visits. CVD events were assessed from Visit 3 through December 31, 2016. Hazard ratios (HR) for the association of persistent BP control with CVD outcomes were adjusted for age, sex, systolic BP, smoking, diabetes, and total and high-density lipoprotein cholesterol at Visit 3.
Results:
At Visit 1, 1,226 of 1,604 participants (76.4%) with hypertension had controlled BP. Overall, 48.9% of participants taking antihypertensive medication at Visit 1 had persistent BP control. After multivariable adjustment for demographic, socioeconomic, clinical, behavioral, and psychosocial factors, and access-to-care, participants were more likely to have persistent BP control if they were <65 years of age, women, had family income ≥$25,000 at each visit, and visited a health professional in the year prior to each visit. The multivariable adjusted HR (95% confidence interval) comparing participants with versus without persistent BP control was 0.71 (0.46-1.10) for CVD, 0.68 (0.34-1.34) for coronary heart disease, 0.65 (0.27-1.52) for stroke, and 0.55 (0.33-0.90) for heart failure.
Conclusion:
Less than half of JHS participants taking antihypertensive medication had persistent BP control, putting them at increased risk for heart failure.
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