Prevalence, awareness, treatment and control of hypertension in a Sub-Saharan African cohort (original) (raw)

Journal of the American Society of Hypertension

African Americans have higher reported hypertension prevalence and lower control rates than other ethnic groups in the United States. Hypertension prevalence, awareness, treatment, and control (outcomes) and potentially associated demographic, lifestyle, comorbidity, and health care access factors were examined in 5249 adult participants (3362 women and 1887 men) aged 21 to 94 years enrolled in the Jackson Heart Study. Hypertension prevalence (62.9%), awareness (87.3%), treatment (83.2%), and control (66.4%) were high. Control declined with advancing age; estimates for all of the outcomes were higher for women compared with men. Lower socioeconomic status was associated with prevalence and control. Smoking was negatively associated with awareness and treatment, particularly among men. Comorbidities (diabetes, chronic kidney disease, and cardiovascular disease), likely driven by the high rates of obesity, correlated with hypertension prevalence, awareness, treatment, and control. Lack of health insurance was marginally associated with poorer control, whereas use of preventive care was positively associated with prevalence, awareness, and treatment, particularly among men. In comparisons with the 1994-2004 National Health and Nutrition Examination Survey data adjusted to Jackson Heart Study sex, age, and socioeconomic status distribution, control rates among Jackson Heart Study participants appeared to be higher than in their national counterparts and similar to that of whites. These results suggest that public health efforts to increase awareness and treatment among African Americans have been relatively effective. The Jackson Heart Study data indicate that better control rates can be achieved in this high-risk population. (Hypertension. 2008;51:650-656.) Key Words: hypertension Ⅲ detection and control Ⅲ population Ⅲ epidemiology Ⅲ blood pressure Ⅲ ethnicity H ypertension is likely the single most important modifiable risk factor for cardiovascular disease (CVD), yet blood pressure (BP) control (Ͻ140/90 mm Hg) is reported in just over one third of all hypertensive participants, with widening disparities among treated African Americans. 1-5 Few studies have examined the levels of awareness, treatment, and control of hypertension among an all-African American population. The Jackson Heart Study (JHS), a community-based CVD study in an African-American cohort, offers a rich data source for extensive examination of factors contributing to these levels. Prevalence of hypertension, awareness of BP elevation, treatment with antihypertensive medications, and rate of BP control were described for the JHS cohort as a whole. Differences among subgroups classified by prevalence, awareness, treatment, and control levels were examined in relation to important demographic and health status characteristics. Findings were compared with those from National Health and Nutrition Examination Survey (NHANES) 1999-2004 sex, age, and education/income (socioeconomic status) adjusted for JHS parameters (JHS-NHANES) and the baseline examination of the all-African-American participants from the Jackson site of the Atherosclerosis Risk in Communities (ARIC) Study. 6 Methods The JHS is a single-site cohort study of CVD in African Americans residing in the Jackson metropolitan statistical area. From September 2000 to March 2004, 5302 participants were recruited and examined, including Ϸ50% (1626) of the living ARIC cohort. 7,8 The original JHS recruitment limited the age range to 35 to 84 and permitted relatives Ͻ35 years and Ͼ84 years to participate to increase the power of the family component. 9 The final age range was 21 to 94 years. The study was approved by the institutional review boards of the participating institutions: the University of Mississippi Medical Center, Jackson State University, and Tougaloo College. All of the participants provided informed consent.