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Prevalence of masked hypertension in adults from a US nationally representative sample
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Abstracts / Journal of the American Society of Hypertension 9(4S) (2015) e63–e72
P-112 Trends in hypertension prevalence among US blacks and whites Joseph Ravenell, Azizi Seixas, Ferdinand Zizi, Girardin Jean-Louis, Gbenga Ogedegbe. Center for Healthful Behavior Change New York University School of Medicine, New York, NY, United States Purpose: Despite significant advances in the management of hypertension over the last 40 years, blacks are still disproportionately burdened by this condition. The aim of the present study was to assess the prevalence of hypertension between black and white adults in the United States over a forty-year span. Method: We used data from the National Health Interview Survey (NHIS) dataset beginning in 1983 and ending in 2013. NHIS dataset is an on-going, nationally representative, cross-sectional study of noninstitutionalized US adults ( 18 years). This yielded data from 361,024 persons of different birthplaces from 54,612 households. Our sample represented a total of 357,342 adults (Whites ¼ 302,730 and blacks ¼ 58,294). Respondents provided sociodemographic and physician-diagnosed chronic conditions. Results: The average age of black and white adults was 43 years and 45 years, respectively. There were more black (56.0%) than white females (51.2%). Blacks were less likely to complete high school (56.3% vs. 64.4%), be employed in the past 12 months (27.6% vs. 6.1%), or be married (36.3% vs. 58.6%); all p < 0.05. Overall, prevalence of hypertension increased from 24.7% in 1983 to 32.5 in 2013. Over the 40 year period, Blacks consistently reported higher prevalence of hypertension than whites. The difference in adjusted prevalence rates blacks and whites increased from 11.6% in 1985 to 16% in 2010. Age and sex-adjusted logistic regressions showed that US black adults were 1.87 times [OR¼1.87, 95% CI¼1.76-1.99, p<.001] to report hypertension, compared to white adults. Adjustment for all sociodemographic factors reduced the odds ratio [OR¼1.77, 95% CI¼1.70-1.84, p<.001]. With further adjustment for health risk and chronic diseases, odds rations were further reduced [OR¼1.56, 95% CI¼1.50-1.62, p<.001]. Conclusion: Relative to whites, blacks reported higher rates of hypertension over time. The disparity in the prevalence of hypertension between black and white did not decline, and may have increased. More research on the mechanisms of hypertension disparities is needed. Support: This work was supported by funding from the NIH (R01MD007716), the NINDS (U54NS081765), and the NHLBI (K24HL111315). Keywords: Hypertension trends; African Americans; Disparity
P-113 Prevalence of masked hypertension in adults from a US nationally representative sample Joseph E. Schwartz,1 Daichi Shimbo,1 Paul Muntner,2 Andrew E. Moran,1 Yan Quan,1 Y. Claire Wang.1 1Columbia University Medical Center, New York, NY, United States; 2University of Alabama at Birmingham, Birmingham, AL, United States Background: Masked hypertension (MHT) is defined as having blood pressure (BP) that is non-elevated in the clinic setting (<140/90 mmHg), but meets the criteria for hypertension (HT) based on ambulatory BP (average awake 135/85 mmHg) in individuals not taking antihypertensive medication. People with MHT are at increased risk for cardiovascular disease (CVD) events and mortality, compared to those with non-elevated clinic and ambulatory BP (ABP). Currently, there are no prevalence estimates for MHT among US adults. Methods: In the Masked Hypertension Study, 894 individuals (without CVD, renal failure, or treated HT; 59% female, 7% Black, 12% Hispanic, mean age of 45 [SD¼10] years) had their clinic BP (CBP) measured by a trained nurse/technician at their first visit (3 readings, averaged). They
Estimated prevalence of MHT among US adults with non-elevated clinic BP in the 2001-2006 NHANES*
Total By Sex Male Female By Age Group (years) 21-44 45-64 65 and over By CBP range (mmHg) >¼120/80 and >¼130/85 and Diabetes No Yes Chronic Kidney Disease No Yes
Estimate
95% CI
13.3%
10.7 - 15.9%
17.3% 8.6%
13.3 - 21.2% 5.9 - 11.4%
9.8% 19.4% 20.5%
7.1 - 12.6% 15.2 - 23.5% 12.3 - 28.8%
7.1% 17.2% 30.8%
4.7 - 9.5% 13.1 - 21.4% 24.7 - 36.9%
13.0% 20.1%
10.4 - 15.6% 11.7 - 28.5%
13.0% 17.1%
10.4 - 15.6% 11.4 - 22.9%
* Excludes persons currently taking antihypertensive medication or with a history of cardiovascular disease.CI: confidence interval
wore a Spacelabs 90207 ABP monitor (Snoqualmie, WA) for 24 hours, with sleep/wake times determined by actigraphy (ActiWatch; Philips Respironics, Bend, OR) supplemented by self-report. These data were merged with the 2001-2006 NHANES surveys and multiple imputation was used to generate 500 datasets with imputed average awake ABP values based on the CBP, sex, age, race/ethnicity, body mass index, and smoking status available in both studies and the association of these to ABP-defined HT status in the MHT study. The US prevalence of MHT was estimated from the CBP and imputed ABP HT status in NHANES. Sampling weights were applied to produce US population estimates. Results: In NHANES, the estimated prevalence among adults without elevated CBP, CVD, renal failure, or treated HT was 13.3% (95% CI: 10.7-15.9%); approximately 16.1 million US adults (95% CI: 13.0-19.2 million; see Table). The prevalence of MHT was disproportionally higher in males, and in individuals who were older or had prehypertension, diabetes or chronic kidney disease. Conclusions: We estimate that over 16 million US adults with nonelevated CBP have MHT. The measurement of BP in the clinic setting alone for HT screening fails to identify approximately 13 out of 100 adults who would be diagnosed as having hypertension by ambulatory BP monitoring. Given the high prevalence of MHT among US adults, studies are needed to determine the costs/benefits of identifying and treating MHT among those with non-elevated CBP. Support from NIH (P01-HL47540) is gratefully acknowledged. Keywords: Masked Hypertension; US prevalence; Ambulatory Blood Pressure Monitoring
P-114 Registry and prognosis study in korean patients with pulmonary arterial hypertension Hye-Sun Seo. Rking group KORPAH (Korean Pulmonary Arterial Hypertension) wo Soonchunhyang universtiy hospital, Bucheon, Republic of Korea Background: We sought to evaluate the clinical features, the status of treatment and prognosis data of Korean patients with pulmonary arterial hypertension (PAH).
Abstracts / Journal of the American Society of Hypertension 9(4S) (2015) e63–e72
P-112 Trends in hypertension prevalence among US blacks and whites Joseph Ravenell, Azizi Seixas, Ferdinand Zizi, Girardin Jean-Louis, Gbenga Ogedegbe. Center for Healthful Behavior Change New York University School of Medicine, New York, NY, United States Purpose: Despite significant advances in the management of hypertension over the last 40 years, blacks are still disproportionately burdened by this condition. The aim of the present study was to assess the prevalence of hypertension between black and white adults in the United States over a forty-year span. Method: We used data from the National Health Interview Survey (NHIS) dataset beginning in 1983 and ending in 2013. NHIS dataset is an on-going, nationally representative, cross-sectional study of noninstitutionalized US adults ( 18 years). This yielded data from 361,024 persons of different birthplaces from 54,612 households. Our sample represented a total of 357,342 adults (Whites ¼ 302,730 and blacks ¼ 58,294). Respondents provided sociodemographic and physician-diagnosed chronic conditions. Results: The average age of black and white adults was 43 years and 45 years, respectively. There were more black (56.0%) than white females (51.2%). Blacks were less likely to complete high school (56.3% vs. 64.4%), be employed in the past 12 months (27.6% vs. 6.1%), or be married (36.3% vs. 58.6%); all p < 0.05. Overall, prevalence of hypertension increased from 24.7% in 1983 to 32.5 in 2013. Over the 40 year period, Blacks consistently reported higher prevalence of hypertension than whites. The difference in adjusted prevalence rates blacks and whites increased from 11.6% in 1985 to 16% in 2010. Age and sex-adjusted logistic regressions showed that US black adults were 1.87 times [OR¼1.87, 95% CI¼1.76-1.99, p<.001] to report hypertension, compared to white adults. Adjustment for all sociodemographic factors reduced the odds ratio [OR¼1.77, 95% CI¼1.70-1.84, p<.001]. With further adjustment for health risk and chronic diseases, odds rations were further reduced [OR¼1.56, 95% CI¼1.50-1.62, p<.001]. Conclusion: Relative to whites, blacks reported higher rates of hypertension over time. The disparity in the prevalence of hypertension between black and white did not decline, and may have increased. More research on the mechanisms of hypertension disparities is needed. Support: This work was supported by funding from the NIH (R01MD007716), the NINDS (U54NS081765), and the NHLBI (K24HL111315). Keywords: Hypertension trends; African Americans; Disparity
P-113 Prevalence of masked hypertension in adults from a US nationally representative sample Joseph E. Schwartz,1 Daichi Shimbo,1 Paul Muntner,2 Andrew E. Moran,1 Yan Quan,1 Y. Claire Wang.1 1Columbia University Medical Center, New York, NY, United States; 2University of Alabama at Birmingham, Birmingham, AL, United States Background: Masked hypertension (MHT) is defined as having blood pressure (BP) that is non-elevated in the clinic setting (<140/90 mmHg), but meets the criteria for hypertension (HT) based on ambulatory BP (average awake 135/85 mmHg) in individuals not taking antihypertensive medication. People with MHT are at increased risk for cardiovascular disease (CVD) events and mortality, compared to those with non-elevated clinic and ambulatory BP (ABP). Currently, there are no prevalence estimates for MHT among US adults. Methods: In the Masked Hypertension Study, 894 individuals (without CVD, renal failure, or treated HT; 59% female, 7% Black, 12% Hispanic, mean age of 45 [SD¼10] years) had their clinic BP (CBP) measured by a trained nurse/technician at their first visit (3 readings, averaged). They
Estimated prevalence of MHT among US adults with non-elevated clinic BP in the 2001-2006 NHANES*
Total By Sex Male Female By Age Group (years) 21-44 45-64 65 and over By CBP range (mmHg) >¼120/80 and >¼130/85 and Diabetes No Yes Chronic Kidney Disease No Yes
Estimate
95% CI
13.3%
10.7 - 15.9%
17.3% 8.6%
13.3 - 21.2% 5.9 - 11.4%
9.8% 19.4% 20.5%
7.1 - 12.6% 15.2 - 23.5% 12.3 - 28.8%
7.1% 17.2% 30.8%
4.7 - 9.5% 13.1 - 21.4% 24.7 - 36.9%
13.0% 20.1%
10.4 - 15.6% 11.7 - 28.5%
13.0% 17.1%
10.4 - 15.6% 11.4 - 22.9%
* Excludes persons currently taking antihypertensive medication or with a history of cardiovascular disease.CI: confidence interval
wore a Spacelabs 90207 ABP monitor (Snoqualmie, WA) for 24 hours, with sleep/wake times determined by actigraphy (ActiWatch; Philips Respironics, Bend, OR) supplemented by self-report. These data were merged with the 2001-2006 NHANES surveys and multiple imputation was used to generate 500 datasets with imputed average awake ABP values based on the CBP, sex, age, race/ethnicity, body mass index, and smoking status available in both studies and the association of these to ABP-defined HT status in the MHT study. The US prevalence of MHT was estimated from the CBP and imputed ABP HT status in NHANES. Sampling weights were applied to produce US population estimates. Results: In NHANES, the estimated prevalence among adults without elevated CBP, CVD, renal failure, or treated HT was 13.3% (95% CI: 10.7-15.9%); approximately 16.1 million US adults (95% CI: 13.0-19.2 million; see Table). The prevalence of MHT was disproportionally higher in males, and in individuals who were older or had prehypertension, diabetes or chronic kidney disease. Conclusions: We estimate that over 16 million US adults with nonelevated CBP have MHT. The measurement of BP in the clinic setting alone for HT screening fails to identify approximately 13 out of 100 adults who would be diagnosed as having hypertension by ambulatory BP monitoring. Given the high prevalence of MHT among US adults, studies are needed to determine the costs/benefits of identifying and treating MHT among those with non-elevated CBP. Support from NIH (P01-HL47540) is gratefully acknowledged. Keywords: Masked Hypertension; US prevalence; Ambulatory Blood Pressure Monitoring
P-114 Registry and prognosis study in korean patients with pulmonary arterial hypertension Hye-Sun Seo. Rking group KORPAH (Korean Pulmonary Arterial Hypertension) wo Soonchunhyang universtiy hospital, Bucheon, Republic of Korea Background: We sought to evaluate the clinical features, the status of treatment and prognosis data of Korean patients with pulmonary arterial hypertension (PAH).