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Nain P, Stabellini N, Makram OM, Rast J, Yerraguntla S, Gopu G, Bhave A, Seth L, Patel V, Jiang S, Malik S, Shetewi A, Montero AJ, Cullen J, Agarwal N, Wang X, Ky B, Baldassarre LA, Weintraub NL, Harris RA, Guha A. Adverse social determinants of health elevate uncontrolled hypertension risk: a cardio-oncology prospective cohort study. JNCI Cancer Spectr 2024; 8:pkae064. [PMID: 39115393 PMCID: PMC11368120 DOI: 10.1093/jncics/pkae064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 06/14/2024] [Accepted: 06/25/2024] [Indexed: 09/03/2024] Open
Abstract
The role of social determinants of health (SDOH) in controlling hypertension (HTN) in cancer patients is unknown. We hypothesize that high SDOH scores correlate with uncontrolled HTN in hypertensive cancer patients. In our prospective study, patients completed the Protocol for Responding to & Assessing Patients' Assets, Risks & Experiences questionnaire. After integrating home and clinic blood pressure readings, uncontrolled HTN was defined as systolic blood pressure greater than or equal to 140 mm Hg and/or diastolic blood pressure greater than or equal to 90 mm Hg. Using Cox regression, we analyzed the impact of SDOH on HTN control, adjusting for relevant factors. The study involved 318 participants (median age 66.4, median follow-up 166 days, SDOH score 6.5 ± 3.2), with stress, educational insecurity, and social isolation as prevalent adverse SDOH. High SDOH scores led to 77% increased risk of uncontrolled HTN (adjusted hazards ratio = 1.77; 95% confidence interval = 1.10 to 2.83, P = .018). Urban residents with high SDOH scores were at an even greater risk. Identifying SDOH and mitigating underlying factors may help control HTN, the most typical disease process treated in all cardio-oncology clinics.
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Affiliation(s)
- Priyanshu Nain
- Department of Medicine, Division of Cardiology, and Vascular Biology Center, Medical College of Georgia at Augusta University, Augusta, GA, USA
- Cardio-Oncology Program, Department of Medicine, Cardiology Division, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Nickolas Stabellini
- Cardio-Oncology Program, Department of Medicine, Cardiology Division, Medical College of Georgia at Augusta University, Augusta, GA, USA
- Division of Hematology and Oncology, Department of Medicine, University Hospitals/Seidman Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Omar M Makram
- Department of Medicine, Division of Cardiology, and Vascular Biology Center, Medical College of Georgia at Augusta University, Augusta, GA, USA
- Cardio-Oncology Program, Department of Medicine, Cardiology Division, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Johnathan Rast
- Department of Internal Medicine, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | | | - Gaurav Gopu
- Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Aditya Bhave
- Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Lakshya Seth
- Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Vraj Patel
- Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Stephanie Jiang
- Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Sarah Malik
- Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Ahmed Shetewi
- Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Alberto J Montero
- Division of Hematology and Oncology, Department of Medicine, University Hospitals/Seidman Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jennifer Cullen
- Cancer Population Sciences, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | - Neeraj Agarwal
- Division of Medical Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Xiaoling Wang
- Georgia Prevention Institute, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Bonnie Ky
- Department of Biostatistics, Epidemiology, & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Division of Cardiology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lauren A Baldassarre
- Section of Cardiovascular Medicine, Department of Medicine and Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Neal L Weintraub
- Department of Medicine, Division of Cardiology, and Vascular Biology Center, Medical College of Georgia at Augusta University, Augusta, GA, USA
- Cardio-Oncology Program, Department of Medicine, Cardiology Division, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Ryan A Harris
- Georgia Prevention Institute, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Avirup Guha
- Department of Medicine, Division of Cardiology, and Vascular Biology Center, Medical College of Georgia at Augusta University, Augusta, GA, USA
- Cardio-Oncology Program, Department of Medicine, Cardiology Division, Medical College of Georgia at Augusta University, Augusta, GA, USA
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Metlock FE, Hinneh T, Benjasirisan C, Alharthi A, Ogungbe O, Turkson-Ocran RAN, Himmelfarb CR, Commodore-Mensah Y. Impact of Social Determinants of Health on Hypertension Outcomes: A Systematic Review. Hypertension 2024; 81:1675-1700. [PMID: 38887955 DOI: 10.1161/hypertensionaha.123.22571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
Despite ample evidence linking social determinants of health (SDoH) and hypertension outcomes, efforts to address SDoH in the context of hypertension prevention and self-management are not commensurate with the burden and impact of hypertension. To provide valuable insights into the development of targeted and effective strategies for preventing and managing hypertension, this systematic review, guided by the Healthy People 2030 SDoH framework, aims to summarize the inclusion, measurement, and evaluation of SDoH in studies examining hypertension outcomes, with a focus on characterizing SDoH constructs and summarizing the current evidence of their influence on hypertension outcomes. Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, a comprehensive search of electronic databases identified 10 608 unique records, from which 57 articles meeting inclusion criteria were analyzed. The studies, conducted nationally or regionally across the United States, revealed that higher educational attainment, health insurance coverage, income, and favorable neighborhood characteristics were associated with lower hypertension prevalence and better hypertension control among US adults. The findings underscore the importance of addressing SDoH such as education, health care access, economic stability, neighborhood environments, and social context to reduce hypertension disparities. Multilevel collaboration and community-engaged practices are necessary to tackle these disparities effectively.
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Affiliation(s)
- Faith E Metlock
- Johns Hopkins School of Nursing, Baltimore, MD (F.E.M., T.H., C.B., O.O., C.R.H., Y.C.-M.)
| | - Thomas Hinneh
- Johns Hopkins School of Nursing, Baltimore, MD (F.E.M., T.H., C.B., O.O., C.R.H., Y.C.-M.)
| | | | | | - Oluwabunmi Ogungbe
- Johns Hopkins School of Nursing, Baltimore, MD (F.E.M., T.H., C.B., O.O., C.R.H., Y.C.-M.)
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (C.R.H., O.O., Y.C.-M.)
| | - Ruth-Alma N Turkson-Ocran
- Department of Medicine, Research Section, Beth Israel Deaconess Medical Center, Boston, MA (R.-A.N.T.-O.)
- Harvard School of Medicine, Boston, MA (R.-A.N.T.-O.)
| | - Cheryl R Himmelfarb
- Johns Hopkins School of Nursing, Baltimore, MD (F.E.M., T.H., C.B., O.O., C.R.H., Y.C.-M.)
- Johns Hopkins School of Medicine, Baltimore, MD (C.R.H.)
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (C.R.H., O.O., Y.C.-M.)
| | - Yvonne Commodore-Mensah
- Johns Hopkins School of Nursing, Baltimore, MD (F.E.M., T.H., C.B., O.O., C.R.H., Y.C.-M.)
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (C.R.H., O.O., Y.C.-M.)
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Cornell PY, Hua CL, Buchalksi ZM, Chmelka GR, Cohen AJ, Daus MM, Halladay CW, Harmon A, Silva JW, Rudolph JL. Using social risks to predict unplanned hospital readmission and emergency care among hospitalized Veterans. Health Serv Res 2024. [PMID: 38972911 DOI: 10.1111/1475-6773.14353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
OBJECTIVES (1) To estimate the association of social risk factors with unplanned readmission and emergency care after a hospital stay. (2) To create a social risk scoring index. DATA SOURCES AND SETTING We analyzed administrative data from the Department of Veterans Affairs (VA) Corporate Data Warehouse. Settings were VA medical centers that participated in a national social work staffing program. STUDY DESIGN We grouped socially relevant diagnoses, screenings, assessments, and procedure codes into nine social risk domains. We used logistic regression to examine the extent to which domains predicted unplanned hospital readmission and emergency department (ED) use in 30 days after hospital discharge. Covariates were age, sex, and medical readmission risk score. We used model estimates to create a percentile score signaling Veterans' health-related social risk. DATA EXTRACTION We included 156,690 Veterans' admissions to a VA hospital with discharged to home from 1 October, 2016 to 30 September, 2022. PRINCIPAL FINDINGS The 30-day rate of unplanned readmission was 0.074 and of ED use was 0.240. After adjustment, the social risks with greatest probability of readmission were food insecurity (adjusted probability = 0.091 [95% confidence interval: 0.082, 0.101]), legal need (0.090 [0.079, 0.102]), and neighborhood deprivation (0.081 [0.081, 0.108]); versus no social risk (0.052). The greatest adjusted probabilities of ED use were among those who had experienced food insecurity (adjusted probability 0.28 [0.26, 0.30]), legal problems (0.28 [0.26, 0.30]), and violence (0.27 [0.25, 0.29]), versus no social risk (0.21). Veterans with social risk scores in the 95th percentile had greater rates of unplanned care than those with 95th percentile Care Assessment Needs score, a clinical prediction tool used in the VA. CONCLUSIONS Veterans with social risks may need specialized interventions and targeted resources after a hospital stay. We propose a scoring method to rate social risk for use in clinical practice and future research.
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Affiliation(s)
- Portia Y Cornell
- Center of Innovation for Long Term Services and Supports, Providence VA Medical Center, Providence, Rhode Island, USA
- Centre for the Digital Transformation of Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Cassandra L Hua
- Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, Massachusetts, USA
| | - Zachary M Buchalksi
- Center of Innovation for Long Term Services and Supports, Providence VA Medical Center, Providence, Rhode Island, USA
| | - Gina R Chmelka
- National Social Work Program, Care Management and Social Work, Patient Care Services, Department of Veterans Affairs, Washington, DC, USA
- Tomah VA Medical Center, Tomah, Wisconsin, USA
| | - Alicia J Cohen
- Department of Health Services, Policy and Practice, Brown University, Providence, Rhode Island, USA
- Department of Family Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | | | - Christopher W Halladay
- Center of Innovation for Long Term Services and Supports, Providence VA Medical Center, Providence, Rhode Island, USA
| | - Alita Harmon
- National Social Work Program, Care Management and Social Work, Patient Care Services, Department of Veterans Affairs, Washington, DC, USA
- Gulf Coast Veterans Health Care System, Biloxi, Mississippi, USA
| | - Jennifer W Silva
- National Social Work Program, Care Management and Social Work, Patient Care Services, Department of Veterans Affairs, Washington, DC, USA
| | - James L Rudolph
- Center of Innovation for Long Term Services and Supports, Providence VA Medical Center, Providence, Rhode Island, USA
- Department of Health Services, Policy and Practice, Brown University, Providence, Rhode Island, USA
- Department of Family Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Yu T, Zhang S, Wakayama R, Horimoto T, Tange C, Nishita Y, Otsuka R. The relationship between the dietary index based Meiji nutritional profiling system for adults and lifestyle-related diseases: a predictive validity study from the National Institute for Longevity Sciences-Longitudinal Study of Aging. Front Nutr 2024; 11:1413980. [PMID: 39021596 PMCID: PMC11252029 DOI: 10.3389/fnut.2024.1413980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 06/19/2024] [Indexed: 07/20/2024] Open
Abstract
Background Nutritional profiling system (NPS) holds promise as a public health tool for companies to measure product healthiness and for individuals in making healthier food choices. The Meiji NPS for adults specifically targets lifestyle-related diseases prevalent among Japan's adult population, including overweight/obesity, hypertension, diabetes, and dyslipidemia. This study examined the cross-sectional association between the Meiji NPS for adults Dietary Index (MNfA-DI) and indicators of lifestyle-related diseases in a population. Methods The study comprised 1,272 middle-aged individuals (40-64 years, 50.1% male) who participated in the seventh wave (2010-2012) of the National Institute for Longevity Sciences-Longitudinal Study of Aging project, with no missing data on three-day dietary records. The MNfA-DI was computed at the individual diet level (accounting for the whole diet) using arithmetic energy-weighted means. A higher MNfA-DI indicated a greater nutritional quality of an individual's overall diet. Lifestyle-related disease indicators included body mass index (BMI, kg/m2), body fat (%), systolic and diastolic blood pressure (mmHg), fasting plasma glucose (mg/dL), HbA1c (%), triglyceride levels (mg/dL), LDL, and HDL cholesterol levels (mg/dL). A multiple regression model was used to assess the association between the MNfA-DI and lifestyle-related disease indicators, adjusting for demographics, socioeconomic status, lifestyle factors, disease history, and energy intake as covariates, depending on the outcome. Results The median (interquartile range) age and MNfA-DI were 53.0 (46.0, 59.0) years and 10.1 (6.0, 14.0) points, respectively. MNfA-DI was negatively associated with body fat [partial regression coefficient (95% confidence interval) -0.04 (-0.07, -0.01)], diastolic blood pressure [-0.08 (-0.17, -0.002)], fasting plasma glucose [-0.18 (-0.33, -0.01)], and triglyceride [-1.36 (-2.16, -0.55)]. Additionally, MNfA-DI was also associated with almost indicators (except for LDL and HDL cholesterol) among participants with a BMI between 18.5 and 24.9 kg/m2. Conclusion These findings suggest that the Meiji NPS for adults could be associated with a lower risk of lifestyle-related diseases. In addition, from a public health nutrition perspective, the Meiji NPS for adults may be useful to assess the food healthiness of the adult population.
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Affiliation(s)
- Tao Yu
- R&D Division Meiji Co., Ltd., Tokyo, Japan
- National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Shu Zhang
- National Center for Geriatrics and Gerontology, Aichi, Japan
| | | | | | - Chikako Tange
- National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Yukiko Nishita
- National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Rei Otsuka
- National Center for Geriatrics and Gerontology, Aichi, Japan
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Aida J, Inoue Y, Tabuchi T, Kondo N. Modifiable risk factors of inequalities in hypertension: analysis of 100 million health checkups recipients. Hypertens Res 2024; 47:1555-1566. [PMID: 38443615 DOI: 10.1038/s41440-024-01615-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 03/07/2024]
Abstract
Inequalities in health behaviors are thought to contribute to inequalities in hypertension. This study examined the extent to which modifiable mediating factors explain income inequalities in hypertension. This repeated cross-sectional study used data from National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) from 2009 to 2015. Those aged between 40 and 74 were enrollees in the Specific Health Checkups. Hypertension was defined as systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90, or the use of antihypertensive medication. The mediating effects of exercise, obesity, smoking, and alcohol drinking on the association between income, as an indicator of SES, and hypertension were determined by the Karlson-Holm-Breen (KHB) method. The mean age of the 68,684,025 men and 59,118,221 women was 54.7 (SD = 9.6) and 56.7 (SD = 10.0) years, respectively. Prevalence of hypertension was higher in the lowest income group (48.6% for men, 40.2% for women) than in the highest income group (33.3% for men, 21.5% for women). Inequalities tended to increase over time. Inequalities were larger among those who did not use antihypertensive medication. Modifiable risks explained 10.6% of the association between income and hypertension for men and 15.1% for women. In men, drinking and obesity explained 8.8% and 5.5% of the inequalities in hypertension, respectively. In women, obesity explained 18.8%. Exercise increased the proportion mediated over time. Smoking explained 5.5% among women taking antihypertensive medication. There were health inequalities in hypertension among Japanese adults, and the modifiable risk factors partially explained the inequalities.
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Affiliation(s)
- Jun Aida
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Yuko Inoue
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Naoki Kondo
- Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan
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Barradas S, Lucumi DI, Mentz G, Agudelo DM. A prospective longitudinal approach to examine the association between social position in childhood, adolescence, and adulthood with the control of hypertension during adulthood. Front Public Health 2024; 12:1296593. [PMID: 38680932 PMCID: PMC11045881 DOI: 10.3389/fpubh.2024.1296593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/25/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction Hypertension is one of the main concerns in public health, since it is related with increased morbidity, and potential years of life lost in addition to loss of quality of life. This study aimed to assess: (1) the distribution of indicators of life course SEP in a cohort of Colombian patients with hypertension and (2) to assess the association of life course SEP and control of hypertension among this cohort of patients. Methods Data were obtained using the baseline survey of 258 patients from the Social Determinants and Inequities in the Control of Blood Hypertension Program (ProDSICHA). Mother occupation and housing conditions were measured with the Event History Calendar. Mother educational level was measured with the questionnaire developed by the Project on Ethnicity and Race in Latin America (PERLA). Socioeconomic position during adulthood was measured using education, occupation, and income level based in the MacArthur Network. Results The group with a higher lifelong social position and the group of lower lifelong social position showed better control of hypertension (OR = 1.21; p <0.05; OR = 1.33; p < .05, respectively) compared to those whose social position throughout life varied the most. No statistical differences were found in the relations between single lifetime social position variables, and hypertension control in the three time points analyzed. Discussion These findings warrant further research to deeper our understanding on the role of a multidimensional and cumulative approach of social position in hypertension control.
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Affiliation(s)
- Susana Barradas
- School of Social and Human Sciences, Universidad Externado de Colombia, Bogotá, Colombia
| | - Diego I. Lucumi
- Alberto Lleras Camargo School of Government, Universidad de los Andes, Bogotá, Colombia
| | - Graciela Mentz
- Statistician Lead, Anethesiology Department, Medical School, University of Michigan, Ann Arbor, MI, United States
| | - Diana Maria Agudelo
- Psychology Department, School of Social Sciences, Universidad de los Andes, Bogotá, Colombia
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Salerno PR, Chen Z, Wass S, Motairek I, Elamm C, Salerno LM, Hassani NS, Deo SV, Al-Kindi SG. Sex-specific heart failure burden across the United States: Global burden of disease 1990-2019. Am Heart J 2024; 269:35-44. [PMID: 38109986 DOI: 10.1016/j.ahj.2023.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/30/2023] [Accepted: 12/10/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Heart failure (HF) has unique aspects that vary by biological sex. Thus, understanding sex-specific trends of HF in the US population is crucial to develop targeted interventions. We aimed to analyze the burden of HF in female and male patients across the US, from 1990 to 2019. METHODS Using the Global Burden of Disease (GBD) study data from 2019, we performed an analysis of the burden of HF from 1990-2019, across US states and regions. The GBD defined HF through studies that used symptom-based criteria and expressed the burden of HF as the age-adjusted prevalence and years lived with disability (YLDs) rates per 100,000 individuals. RESULTS The age-adjusted prevalence of HF for the US in 2019 was 926.2 (95% UI [799.6, 1,079.0]) for females and 1,291.2 (95% UI [1,104.1, 1,496.8]) for males. Notably, our findings also highlight cyclic fluctuations in HF prevalence over time, with peaks occurring in the mid-1990s and around 2010, while reaching their lowest points in around 2000 and 2018. Among individuals >70 years of age, the absolute number of individuals with HF was higher in females, and this age group doubled the absolute count between 1990 and 2019. Comparing 1990-1994 to 2015-2019, 10 states had increased female HF prevalence, while only 4 states increased male prevalence. Overall, Western states had the greatest relative decline in HF burden, in both sexes. CONCLUSION The burden of HF in the US is high, although the magnitude of this burden varies according to age, sex, state, and region. There is a significant increase in the absolute number of individuals with HF, especially among women >70 years, expected to continue due to the aging population.
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Affiliation(s)
- Pedro Rvo Salerno
- Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University School of Medicine, Cleveland, OH
| | - Zhuo Chen
- Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University School of Medicine, Cleveland, OH
| | - Sojin Wass
- Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University School of Medicine, Cleveland, OH
| | - Issam Motairek
- Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University School of Medicine, Cleveland, OH
| | - Chantal Elamm
- Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University School of Medicine, Cleveland, OH; Section of Advanced Heart Failure and Transplantation, University Hospitals, Cleveland, OH
| | - Lúcia Mvo Salerno
- Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Brazil
| | - Neda Shafiabadi Hassani
- Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University School of Medicine, Cleveland, OH
| | - Salil V Deo
- Surgical Services, Louis Stokes VA Hospital, Cleveland, OH
| | - Sadeer G Al-Kindi
- Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University School of Medicine, Cleveland, OH; Section of Advanced Heart Failure and Transplantation, University Hospitals, Cleveland, OH.
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Delolmo-Romero S, Correa-Rodríguez M, Sánchez-Martínez MC, Gil-Gutiérrez R, Ortego-Centeno N, Rueda-Medina B. Social Health and Its Influence on Metabolic Health Among a Rural Population: A Cross-Sectional Study. Clin Nurs Res 2024; 33:9-18. [PMID: 37382362 DOI: 10.1177/10547738231184935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
The aim of this study was to estimate the prevalence of metabolic syndrome (MetS) in a Spanish rural population and assess differences in prevalence according to loneliness level, social isolation, and social support. This is a cross-sectional study of 310 patients. MetS was defined by National Cholesterol Education Program-Third Adult Treatment Panel. The UCLA (University of California, Los Angeles) Loneliness Scale, Multidimensional Scale of Social Support, and Lubben Social Network Scale were used to assess loneliness, perceived social support, and social isolation. Almost half of the participants fulfilled MetS diagnosis criteria. Subjects with MetS showed significantly higher levels of loneliness, less social support, and greater social isolation. Systolic blood pressure was significantly higher in socially isolated rural adults. Environmental factors may play a key role in the prevalence of MetS, so specific screening and prevention programs could help health professionals prevent the increasing rates of MetS in rural populations under these socially specific conditions of vulnerability.
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Affiliation(s)
- Sara Delolmo-Romero
- Department of Nursing, Faculty of Health Sciences, University of Granada, Spain
- Instituto de Investigación Biosanitaria IBS GRANADA, Spain
| | - María Correa-Rodríguez
- Department of Nursing, Faculty of Health Sciences, University of Granada, Spain
- Instituto de Investigación Biosanitaria IBS GRANADA, Spain
| | | | - Rocío Gil-Gutiérrez
- Department of Nursing, Faculty of Health Sciences, University of Granada, Spain
- Instituto de Investigación Biosanitaria IBS GRANADA, Spain
| | - Norberto Ortego-Centeno
- Department of Nursing, Faculty of Health Sciences, University of Granada, Spain
- Department of Medicine, Faculty of Medicine, University of Granada, Spain
| | - Blanca Rueda-Medina
- Department of Nursing, Faculty of Health Sciences, University of Granada, Spain
- Instituto de Investigación Biosanitaria IBS GRANADA, Spain
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Labgold K, Howards PP, Drews-Botsch C, Dunlop AL, Bryan JM, Ruddock T, Johnston S, Kramer MR. Decomposing the Black-White Racial Disparity in Severe Maternal Morbidity Risk: The Role of Hypertensive Disorders of Pregnancy. Epidemiology 2024; 35:94-102. [PMID: 37793115 DOI: 10.1097/ede.0000000000001683] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
BACKGROUND To our knowledge, no studies have explicitly studied the role of hypertensive disorders of pregnancy (HDP) in racial disparities in severe maternal morbidity (SMM). METHODS Using causal mediation models, we estimated the proportion of the non-Hispanic (NH) Black-White racial disparity in risk of SMM that is explained through the pathway of HDP. We linked 2006-2019 Georgia hospital discharge records with vital statistics birth and fetal death records for NH Black and NH White birthing persons. We used G-estimation of a structural nested mean model to decompose the absolute racial disparity in the incidence of SMM into pathways operating through HDP. RESULTS NH Black birthing people experienced an excess 56 SMM events (95% confidence interval [CI] = 52, 59) per 10,000 delivery hospitalizations compared with NH White birthing people. If counterfactual disparity measure estimation assumptions hold, the estimated absolute disparity remaining after blocking the causal pathways through HDP was 41 SMM events per 10,000 deliveries (95% CI = 38, 44), suggesting that 26% (95% CI = 12, 40) of the absolute racial disparity would be eliminated if there was no contribution of HDP to SMM risk. CONCLUSION Our results are consistent with the hypothesis that intervening to prevent HDP is an important (yet incomplete) pathway for reducing the excess risk among NH Black pregnancies compared with NH White pregnancies.
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Affiliation(s)
- Katie Labgold
- From the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Penelope P Howards
- From the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Carolyn Drews-Botsch
- From the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
- Department of Global and Community Health, School of Health and Human Services, George Mason University, Fairfax, VA
| | - Anne L Dunlop
- From the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
- Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, GA
| | | | | | | | - Michael R Kramer
- From the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
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Prieto-Díaz MA, Pallares-Carratala V, Manuel Micó-Pérez R, Escobar-Cervantes C, Martín-Sanchez V, Coca A, Barquilla-García A, Velilla-Zancada SM, Polo-García J, Segura-Fragoso A, Ginel-Mendoza L, Hermida-Ameijerias Á, Cinza-Sanjurjo S. Clinical characteristics, treatment, and blood pressure control in patients with hypertension seen by primary care physicians in Spain: the IBERICAN study. Front Cardiovasc Med 2023; 10:1295174. [PMID: 38173815 PMCID: PMC10763308 DOI: 10.3389/fcvm.2023.1295174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/29/2023] [Indexed: 01/05/2024] Open
Abstract
Objectives To determine the clinical profile, according to the history of hypertension, the risk of developing hypertension, current antihypertensive treatment and BP control rates in patients with hypertension from the IBERICAN cohort. Methods IBERICAN is an ongoing prospective cohort study, whose primary objective is to determine the frequency, incidence, and distribution of CVRF in the adult Spanish population seen in primary care settings. This analysis shows the baseline clinical characteristics of patients with hypertension. Adequate BP control was defined as BP <140/90 mmHg according to 2013 ESH/ESC guidelines. Results A total of 8,066 patients were consecutively included, of whom 3,860 (48.0%) had hypertension. These patients were older (65.8 ± 10.9 vs. 51.6 ± 14.7 years; p < 0.001), had more cardiovascular risk factors, target organ damage and cardiovascular disease (CVD) in comparison with those without hypertension. The risk of hypertension increased with the presence of associated CV risk factors and comorbidities, particularly diabetes, obesity and the metabolic syndrome, and decreased with the intensity of physical activity. Regarding antihypertensive treatments, 6.1% of patients did not take any medication, 38.8% were taking one antihypertensive drug, 35.5% two drugs, and 19.6% three or more antihypertensive drugs. Overall, 58.3% achieved BP goals <140/90 mmHg. A greater probability of BP control was observed with increasing age of patients and the greater number of antihypertensive drugs. Blood pressure control was lower in hypertensive patients with diabetes, obesity, the metabolic syndrome, increased urinary albumin excretion, higher pulse pressure, and lack of antihypertensive treatment. Conclusions About half of patients attended in primary care settings have hypertension in Spain. Patients with hypertension have a worse CV clinical profile than non-hypertensive patients, with greater association of CVRF and CVD. Around four out of ten patients do not achieve the recommended BP goals, and higher use of combination therapies is associated with a better BP control.
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Affiliation(s)
- Miguel A. Prieto-Díaz
- Vallobín-La Florida Health Center, Principality of Asturias Health Service, Oviedo, Spain
- Faculty of Medicine, University of Santiago de Compostela, A Coruña, Spain
| | - Vicente Pallares-Carratala
- Health Surveillance Unit, Mutual Insurance Union, Castellon, Spain
- Department of Medicine, Jaume I University, Castellon, Spain
| | | | | | - Vicente Martín-Sanchez
- Institute of Biomedicine (IBIOMED), Epidemiology and Public Health Networking Biomedical Research Centre (CIBERESP), University of León, León, Spain
| | - Antonio Coca
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | | | | | - José Polo-García
- Casar de Cáceres Health Center, Extremadura Health Service, Cáceres, Spain
| | | | | | | | - Sergio Cinza-Sanjurjo
- Milladoiro Health Centre, Health Area of Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), A Coruña, Spain
- Networking Biomedical Research, Centre-Cardiovascular Diseases (CIBERCV), Santiago de Compostela, Spain
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11
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Silberzan L, Kelly-Irving M, Bajos N. [Analysing hypertension in France : A call for an intersectional approach of the cascade of care]. Rev Epidemiol Sante Publique 2023; 71:102159. [PMID: 37729691 DOI: 10.1016/j.respe.2023.102159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/28/2023] [Accepted: 08/28/2023] [Indexed: 09/22/2023] Open
Abstract
In metropolitan France, estimates suggest that more than one in three adults has hypertension. Low-cost treatments are available, yet fewer than one in four hypertensive adults has a controlled level of hypertension below 140/90 mmHg. This rate is higher in other high-income countries such as Canada (65%) or Germany (52%). Using a 'cascade of care' model, that decomposes the hypertension care continuum in awareness, treatment, and control, provides a better understanding of the origins of poor control. Furthermore, the theoretical framework of intersectionality, which simultaneously considers social positions of gender, class, and ethno-racial origin, could be used to understand the complexity of the social inequalities observed in hypertension-related outcomes. In this article we conducted a critical review of the international literature to identify new lines of analyses that could be applied to examine complex inequalities in France.
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Affiliation(s)
- L Silberzan
- Inserm-IRIS (UMR8156 - U997), Inserm, Aubervilliers, France; UMR1295, Toulouse III Université, Inserm, Equipe EQUITY, Equipe constitutive du CERPOP, Toulouse, France.
| | - M Kelly-Irving
- UMR1295, Toulouse III Université, Inserm, Equipe EQUITY, Equipe constitutive du CERPOP, Toulouse, France
| | - N Bajos
- Inserm-IRIS (UMR8156 - U997), Inserm, Aubervilliers, France
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12
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Khaleghi MM, Jamshidi A, Afrashteh S, Emamat H, Farhadi A, Nabipour I, Jalaliyan Z, Malekizadeh H, Larijani B. The association of body composition and fat distribution with hypertension in community-dwelling older adults: the Bushehr Elderly Health (BEH) program. BMC Public Health 2023; 23:2001. [PMID: 37833665 PMCID: PMC10576374 DOI: 10.1186/s12889-023-16950-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/10/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND A significant proportion of the global burden of disability and premature mortality has caused by hypertension. It seems that the relationship between obesity and hypertension is not only associated with excessive body fat mass (FM) but also with body adipose distribution patterns. The present study investigated the association between regional fat distribution using dual-energy X-ray absorptiometry and hypertension in older adults. METHODS This cross-sectional study was performed using the data from Bushehr Elderly Health Program (BEH) on a total of 2419 participants aged 60 and over. Hypertension was defined as SBP of at least 140 mmHg and/or DBP of at least 90 mmHg. SBP between 120 and 139 mmHg and/or a DBP between 80 and 89 mmHg were considered prehypertension. Participants underwent body composition measurement by dual-energy x-ray absorptiometry to analyze FM, fat-free mass (FFM) in trunk and extremities composition. RESULTS The results showed that 460 (19.02%) of participants had prehypertension, and 1,818 (75.15% ) had hypertension. The odds of having prehypertension (OR: 1.06, 95%CI: 1.01-1.12) and hypertension (OR: 1.08, 95%CI: 1.03-1.13) increased with a rise in total body FM percentage. Moreover, people with a higher FM to FFM ratio had increased odds of being prehypertensive (OR: 9.93, 95%CI: 1.28-76.99) and hypertensive (OR: 16.15, 95%CI: 2.47-105.52). Having a higher android to gynoid FM ratio was related to increased odds of being prehypertensive and hypertensive. CONCLUSIONS This study showed that a higher body FM, particularly in the android region, is associated with higher odds of having hypertension in older adults.
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Affiliation(s)
| | - Ali Jamshidi
- The Persian Gulf Tropical Medicine Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran
- Department of Nutritional Sciences, Faculty of Health and Nutrition, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Sima Afrashteh
- Department of Biostatistics and Epidemiology, Faculty of Health and Nutrition, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Hadi Emamat
- The Persian Gulf Tropical Medicine Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran
- Department of Nutritional Sciences, Faculty of Health and Nutrition, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Akram Farhadi
- The Persian Gulf Tropical Medicine Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran.
| | - Iraj Nabipour
- The Persian Gulf Marine Biotechnology Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran
| | | | - Hasan Malekizadeh
- School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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13
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Cummings DM, Adams A, Patil S, Cherrington A, Halladay JR, Oparil S, Soroka O, Ringel JB, Safford MM. Treatment Intensity, Prescribing Patterns, and Blood Pressure Control in Rural Black Patients with Uncontrolled Hypertension. J Racial Ethn Health Disparities 2023; 10:2505-2512. [PMID: 36271193 DOI: 10.1007/s40615-022-01431-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/29/2022] [Accepted: 10/06/2022] [Indexed: 10/24/2022]
Abstract
BACKGROUND/OBJECTIVE Because racial disparities in hypertension treatment persist, the objective of the present study was to examine patient vs. practice characteristics that influence antihypertensive selection and treatment intensity for non-Hispanic Black (hereafter "Black") patients with uncontrolled hypertension in the rural southeastern USA. METHODS We enrolled 25 Black patients from each of 69 rural practices in Alabama and North Carolina with uncontrolled hypertension (systolic blood pressure (BP) ≥ 140 mm Hg) in a 4-arm cluster randomized trial of BP control interventions. Patients' antihypertensive medications were abstracted from medical records and reconciled at the baseline visit. Treatment intensity was computed using the defined daily dose (DDD) method of the World Health Organization. Correlates of greater antihypertensive medication intensity were assessed by linear regression modeling, and antihypertensive medication classes were compared by baseline systolic BP (SBP) level. RESULTS A total of 1431 patients were enrolled and had complete baseline data. Antihypertensive treatment intensity averaged 3.7 ± 2.6 equivalent medications at usual dosages and was significantly related to higher baseline systolic BP, older age, male sex, insurance availability, higher BMI, and concurrent diabetes, but not to practice type or medication barriers in regression models. Renin-angiotensin system inhibitors were the most commonly used medications, followed by diuretics and calcium channel blockers. CONCLUSION/RELEVANCE Antihypertensive treatment intensity for Black patients in the rural southeastern USA with a history of uncontrolled hypertension averaged the equivalent of almost four medications at usual dosages and was significantly associated with baseline SBP levels and other patient characteristics, but not clinic type. TRIAL REGISTRATION ClinicalTrials.gov NCT02866669.
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Affiliation(s)
- Doyle M Cummings
- Departments of Public Health and Family Medicine, Brody School of Medicine, East Carolina University, 115 Heart Drive, Greenville, NC, 27834-8982, USA.
| | - Alyssa Adams
- Departments of Public Health and Family Medicine, Brody School of Medicine, East Carolina University, 115 Heart Drive, Greenville, NC, 27834-8982, USA
| | - Shivajirao Patil
- Departments of Public Health and Family Medicine, Brody School of Medicine, East Carolina University, 115 Heart Drive, Greenville, NC, 27834-8982, USA
| | - Andrea Cherrington
- Divisions of Preventive Medicine and Cardiovascular Disease, University of Alabama-Birmingham, Birmingham, AL, USA
| | | | - Suzanne Oparil
- Divisions of Preventive Medicine and Cardiovascular Disease, University of Alabama-Birmingham, Birmingham, AL, USA
| | - Orysya Soroka
- Division of General Internal Medicine, Weill Cornell Medical Center, New York, NY, USA
| | - Joanna Bryan Ringel
- Division of General Internal Medicine, Weill Cornell Medical Center, New York, NY, USA
| | - Monika M Safford
- Division of General Internal Medicine, Weill Cornell Medical Center, New York, NY, USA
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Affiliation(s)
- Jared W. Magnani
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
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15
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Bala C, Rusu A, Gheorghe-Fronea OF, Benedek T, Pop C, Vijiiac AE, Stanciulescu D, Darabantiu D, Roman G, Dorobantu M. Social and Metabolic Determinants of Prevalent Hypertension in Men and Women: A Cluster Analysis from a Population-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1736. [PMID: 36767102 PMCID: PMC9914893 DOI: 10.3390/ijerph20031736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/14/2023] [Accepted: 01/16/2023] [Indexed: 06/18/2023]
Abstract
Essential hypertension (HTN) has a complex spectrum of pathophysiological determinants and current guidelines provide limited information on high-risk groups that should be targeted for its primary prevention. The objective of our research was to identify clusters of social and metabolic factors associated with prevalent HTN in men and women from a population-based survey in Romania. Of the 1477 participants in the main study, 798 with complete data were analyzed here. Using two-step cluster analysis, one high-risk cluster in women and two high and intermediate risk for prevalent HTN in men were identified. Older age, rural area, lower education, and higher burden of metabolic factors characterized clusters with higher risk, while intermediate risk in men was characterized by a more metabolically healthy phenotype in younger individuals. In logistic regression, men in Cluster 1 vs. those in Cluster 3 had an odds ratio (OR) of 9.6 (95%CI: 4.6; 20.0), p < 0.001 for prevalent HTN, while OR for Cluster 2 vs. Cluster 3 was 3.2 (95%CI: 1.4; 7.4), p = 0.005. In women, the OR for HTN was 10.2 (95%CI: 5.7; 18.5) if assigned to Cluster 2 vs. Cluster 1, p < 0.001. These results pointed out the subgroups and communities that the primary prevention of HTN should be prioritized in.
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Affiliation(s)
- Cornelia Bala
- Department of Diabetes and Nutrition, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
| | - Adriana Rusu
- Department of Diabetes and Nutrition, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
| | - Oana Florentina Gheorghe-Fronea
- Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
- Cardiology Department, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania
| | - Theodora Benedek
- Cardiology Department, County Clinical Emergency Hospital, Faculty of Medicine, “Gheorghe Emil Palade” University of Medicine, Pharmacy, Science, and Technology, 540142 Targu Mures, Romania
| | - Calin Pop
- Emergency Clinical County Hospital Baia Mare, Faculty of Medicine, “Vasile Goldiș” West University, 430130 Baia Mare, Romania
| | - Aura Elena Vijiiac
- Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
- Cardiology Department, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania
| | - Diana Stanciulescu
- Cardiology Department, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania
| | - Dan Darabantiu
- Department of Cardiology, Arad Emergency Clinical County Hospital, Faculty of Medicine, “Vasile Goldiș” West University, 310025 Arad, Romania
| | - Gabriela Roman
- Department of Diabetes and Nutrition, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
| | - Maria Dorobantu
- Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
- Romanian Academy, 010071 Bucharest, Romania
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Adulthood Psychosocial Disadvantages and Risk of Hypertension in U.S. Workers: Effect Modification by Adverse Childhood Experiences. Life (Basel) 2022; 12:life12101507. [PMID: 36294941 PMCID: PMC9604677 DOI: 10.3390/life12101507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 09/22/2022] [Accepted: 09/24/2022] [Indexed: 11/16/2022] Open
Abstract
Hypertension is a key driver of cardiovascular diseases. However, how stressors contribute to the development of hypertension remains unclear. The objective of this study was to examine prospective associations of adverse childhood experiences (ACEs) and adulthood psychosocial disadvantages (APDs) with incident hypertension. Data were from the Mid-life in the United States (MIDUS) study, a national, population-based, prospective cohort study. ACEs were examined via retrospective reports, and APDs including work stress and social isolation were assessed using survey measures. Incident hypertension was defined based on self-reported physician diagnosis. Baseline data were collected in 1995, with follow-up in 2004-2006 and 2013-2014. Cox proportional hazards regression was applied to assess prospective associations of ACEs and APDs with incident hypertension in 2568 workers free from hypertension at baseline. After adjustment for covariates, baseline APDs were associated with increased incident hypertension (aHR and 95% CI = 1.48 [1.09, 2.01]) during a 20-year follow-up, whereas ACEs showed null associations. Moreover, a moderating effect by ACEs was observed-the effect of APDs on risk of hypertension was stronger when ACEs were present (aHR and 95% CI = 1.83 [1.17, 2.86]). These findings underscore the importance of psychosocial stressors as nontraditional risk factors of cardiometabolic disorders.
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