Cardiovascular Health and Hypertension in Blacks

Study Questions:

What is the association between cardiovascular health and incident hypertension in blacks?

Methods:

The investigators analyzed participants without hypertension or cardiovascular disease at baseline (2000–2004) who attended ≥1 follow-up visit in 2005–2008 or 2009–2012 (n = 1,878). Body mass index, physical activity, diet, cigarette smoking, blood pressure (BP), total cholesterol, and fasting glucose were assessed at baseline and categorized as ideal, intermediate, or poor using the American Heart Association’s Life’s Simple 7 definitions. Incident hypertension was defined at the first visit wherein a participant had systolic BP ≥140 mm Hg, diastolic BP ≥90 mm Hg, or self-reported taking antihypertensive medication. The cumulative incidence of hypertension and adjusted hazard ratios for incident hypertension associated with the Life’s Simple 7 score were calculated, overall and for participants with normal BP and prehypertension.

Results:

The percentage of participants with ≤1, 2, 3, 4, 5, and 6 ideal Life’s Simple 7 components was 6.5%, 22.4%, 34.4%, 25.2%, 10.0%, and 1.4%, respectively. No participants had 7 ideal components. During follow-up (median, 8.0 years), 944 (50.3%) participants developed hypertension, including 81.3% with ≤1 and 11.1% with 6 ideal components. The multivariable adjusted hazard ratios (95% confidence interval) for incident hypertension comparing participants with 2, 3, 4, 5, and 6 versus ≤1 ideal component were 0.80 (0.61–1.03), 0.58 (0.45–0.74), 0.30 (0.23–0.40), 0.26 (0.18–0.37), and 0.10 (0.03–0.31), respectively (p trend < 0.001). This association was present among participants with baseline systolic BP <120 mm Hg and diastolic BP <80 mm Hg and separately systolic BP 120-139 mm Hg or diastolic BP 80-89 mm Hg.

Conclusions:

The authors reported that blacks with better cardiovascular health have lower hypertension risk.

Perspective:

This community-based study of blacks reports that two thirds of participants had 3 or fewer ideal Life’s Simple 7 components, and no participants had all 7. There was also a strong, graded association between having more ideal Life’s Simple 7 components and a lower incidence of hypertension. Furthermore, this association was consistent among participants with normal BP and prehypertension. It seems that even modest improvements in cardiovascular health behaviors and risk factors would lower the risk for hypertension in blacks, which in turn should translate into improved cardiovascular outcomes.

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Vascular Medicine, Lipid Metabolism, Nonstatins, Diet, Exercise, Hypertension

Keywords: African Americans, Antihypertensive Agents, Blood Pressure, Body Mass Index, Cholesterol, Diet, Exercise, Glucose, Hypertension, Metabolic Syndrome X, Prehypertension, Primary Prevention, Risk, Vascular Diseases


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