Factors associated with the prevalence of hypertension in the southeastern United States: insights from 69,211 blacks and whites in the Southern Community Cohort Study

Circ Cardiovasc Qual Outcomes. 2014 Jan;7(1):33-54. doi: 10.1161/CIRCOUTCOMES.113.000155. Epub 2013 Dec 23.

Abstract

Background: Lifestyle and socioeconomic status have been implicated in the prevalence of hypertension; thus, we evaluated factors associated with hypertension in a cohort of blacks and whites with similar socioeconomic status characteristics.

Methods and results: We evaluated the prevalence and factors associated with self-reported hypertension (SR-HTN) and ascertained hypertension (A-HTN) among 69,211 participants in the Southern Community Cohort Study. Multivariable logistic regression models were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for factors associated with hypertension. The prevalence of SR-HTN was 57% overall. Body mass index was associated with SR-HTN in all race-sex groups, with the OR rising to 4.03 (95% CI, 3.74-4.33) for morbidly obese participants (body mass index, >40 kg/m(2)). Blacks were more likely to have SR-HTN than whites (OR, 1.84; 95% CI, 1.75-1.93), and the association with black race was more pronounced among women (OR, 2.08; 95% CI, 1.95-2.21) than men (OR, 1.47; 95% CI, 1.36-1.60). Similar findings were noted in the analysis of A-HTN. Among those with SR-HTN and A-HTN who reported use of an antihypertensive agent, 94% were on at least one of the major classes of antihypertensive agents, but only 44% were on ≥2 classes and only 29% were on a diuretic. The odds of both uncontrolled hypertension (SR-HTN and A-HTN) and unreported hypertension (no SR-HTN and A-HTN) were twice as high among blacks as whites (OR, 2.13; 95% CI, 1.68-2.69; and OR, 1.99; 95% CI, 1.59-2.48, respectively).

Conclusions: Despite socioeconomic status similarities, we observed suboptimal use of antihypertensives in this cohort and racial differences in the prevalence of uncontrolled and unreported hypertension, which merit further investigation.

Keywords: African Continental Ancestry Group; European Continental Ancestry Group; hypertension; prevalence.

Publication types

  • Comparative Study
  • Research Support, American Recovery and Reinvestment Act
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • African Continental Ancestry Group / ethnology*
  • Age Factors
  • Aged
  • Body Mass Index
  • Cohort Studies
  • Continental Population Groups
  • Cross-Sectional Studies
  • European Continental Ancestry Group / ethnology*
  • Female
  • Humans
  • Hypertension / epidemiology*
  • Hypertension / ethnology*
  • Life Style*
  • Logistic Models
  • Male
  • Middle Aged
  • Patient Compliance*
  • Prevalence
  • Risk Factors
  • Social Class*
  • Southeastern United States / epidemiology