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Rice B, Mbatidde L, Oluleye O, Onwuanyi A, Adedinsewo D. Managing hypertension in African Americans with heart failure: A guide for the primary care clinician. J Natl Med Assoc 2023:S0027-9684(23)00144-X. [PMID: 38135590 DOI: 10.1016/j.jnma.2023.11.004] [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: 10/11/2023] [Accepted: 11/20/2023] [Indexed: 12/24/2023]
Abstract
Hypertension is the predominant risk factor for cardiovascular disease related morbidity and mortality among Black adults in the United States. It contributes significantly to the development of heart failure and increases the risk of death following heart failure diagnosis. It is also a leading predisposing factor for hypertensive disorders of pregnancy and peripartum cardiomyopathy in Black women. As such, all stakeholders including health care providers, particularly primary care clinicians (including physicians and advanced practice providers), patients, and communities must be aware of the consequences of uncontrolled hypertension among Black adults. Appropriate treatment strategies should be identified and implemented to ensure timely and effective blood pressure management among Black individuals, particularly those with, and at risk for heart failure.
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Affiliation(s)
- Bria Rice
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Lydia Mbatidde
- Department of Family Medicine, Mayo Clinic, Jacksonville, FL, United States
| | | | - Anekwe Onwuanyi
- Department of Cardiovascular Medicine, Morehouse School of Medicine, Atlanta, GA
| | - Demilade Adedinsewo
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States.
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Wang MC, Petito LC, Pool LR, Foti K, Juraschek SP, McEvoy JW, Nambi V, Carnethon MR, Michos ED, Khan SS. The 2017 American College of Cardiology/American Heart Association Hypertension Guideline and Blood Pressure in Older Adults. Am J Prev Med 2023; 65:640-648. [PMID: 37105448 PMCID: PMC10524146 DOI: 10.1016/j.amepre.2023.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/17/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023]
Abstract
INTRODUCTION The 2017 American College of Cardiology/American Heart Association blood pressure guideline redefined hypertension and lowered the blood pressure treatment target. Empirical data on the guideline's impact are needed. METHODS Data were analyzed from Atherosclerosis Risk in Communities study participants who attended baseline pre-guideline (2016-2017) and post-guideline (2018-2019) visits with baseline systolic blood pressure between 120 and 159 mmHg. Participants were grouped according to baseline systolic blood pressure by change in classification under the new guideline as follows: not reclassified (120-129 mmHg), reclassified to Stage 1 hypertension (130-139 mmHg), and reclassified to Stage 2 hypertension (140-159 mmHg). Means and 95% CIs for systolic blood pressure changes between baseline and follow-up, changes in antihypertensive use, and percentages that achieved the post-guideline recommendation (systolic blood pressure <130 mmHg) were calculated. Analyses were performed in 2021-2022. RESULTS Among 2,193 community-dwelling Atherosclerosis Risk in Communities participants aged 71-95 years at baseline, systolic blood pressure changes between baseline and follow-up visits differed among participants not reclassified (+4.1 mmHg, 95% CI=3.0, 5.3 mmHg), reclassified to Stage 1 hypertension (-1.1 mmHg, 95% CI= -2.2, 0.1 mmHg), and reclassified to Stage 2 hypertension (-5.7 mmHg, 95% CI= -6.8, -4.7 mmHg). Antihypertensive use changed from 77.3% to 78.4% (p=0.25) among participants reclassified to Stage 1 hypertension and from 78.3% to 81.4% (p<0.01) among participants reclassified to Stage 2 hypertension. At follow-up, 41.8% of the Stage 1 and 22.4% of the Stage 2 hypertension groups reached the systolic blood pressure <130 mmHg goal. CONCLUSIONS There were small decreases in systolic blood pressure and increases in antihypertensive therapy among older adults reclassified to Stage 2 hypertension but not among those reclassified to Stage 1 hypertension by the 2017 American College of Cardiology/American Heart Association guideline.
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Affiliation(s)
- Michael C Wang
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lucia C Petito
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lindsay R Pool
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kathryn Foti
- Department of Epidemiology, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Stephen P Juraschek
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - John W McEvoy
- National Institute for Prevention and Cardiovascular Health, University of Galway School of Medicine, Galway, Ireland; Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Vijay Nambi
- Michael E DeBakey Veterans Affairs Hital, Baylor College of Medicine, Houston, Texas; Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sadiya S Khan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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Reges O, Krefman AE, Hardy ST, Yano Y, Muntner P, Pool LR, Gordon-Larsen P, Wang Y, Lloyd-Jones DM, Allen NB. Race- and Sex-Specific Factors Associated With Age-Related Slopes in Systolic Blood Pressure: Findings From the CARDIA Study. Hypertension 2023; 80:1890-1899. [PMID: 37470199 DOI: 10.1161/hypertensionaha.123.21217] [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: 03/13/2023] [Accepted: 07/06/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Although blood pressure (BP) increases throughout young adulthood for most individuals, the age-related slope is not uniform. This study aimed to assess associations of demographic, clinical, behavioral, psychosocial, and neighborhood characteristics with age-related BP slope among 4 race-sex groups who participated in the Coronary Artery Risk Development in Young Adults study. METHODS Individuals (n=3554) aged 18 to 30 years were included in this analysis if they had normal BP at baseline and ≥2 BP measurements during the years 1985/1986 to 2015/2016. Associations of exposure variables with systolic BP slope were assessed using multivariate linear models. RESULTS Over a mean follow-up of ~30 years, greater decade increases in systolic BP were estimated among Black than White participants (mean difference between Black females and White females: 3.0 mm Hg/decade; between Black males and White males: 4.7 mm Hg/decade). The exposure risk factors associated with greater increases in systolic BP throughout adulthood varied by race and sex. None of these factors were associated with increases in systolic BP in all race-sex groups. Parent history of high BP was associated with a steeper positive slope among Black females (effect size per decade: 1.1 [95% CI, 0.6-1.6]; P<0.01), Black males (0.6 [95% CI, 0.02-1.2]; P<0.05), and White females (0.6 [95% CI, 0.2-1.0]; P<0.01). Other risk factors were associated with greater age-related yearly increases in systolic BP among 1 or 2 of the 4 race-sex groups or were not statistically significant. CONCLUSIONS Culturally tailored BP reduction approach should be considered in conjunction with primordial prevention, to moderate increases in BP throughout adulthood.
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Affiliation(s)
- Orna Reges
- Department of Health Systems Management, Ariel University, Israel (O.R.)
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL (O.R., A.E.K., L.R.P., Y.W., D.M.L.-J., N.B.A.)
| | - Amy E Krefman
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL (O.R., A.E.K., L.R.P., Y.W., D.M.L.-J., N.B.A.)
| | - Shakia T Hardy
- Department of Epidemiology, University of Alabama at Birmingham (S.T.H., P.M.)
| | - Yuichiro Yano
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC (Y.Y.)
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham (S.T.H., P.M.)
| | - Lindsay R Pool
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL (O.R., A.E.K., L.R.P., Y.W., D.M.L.-J., N.B.A.)
| | - Penny Gordon-Larsen
- Department of Nutrition, University of North Carolina, Gillings School of Global Public Health, Chapel Hill, NC (P.G.-L.)
| | - Yaojie Wang
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL (O.R., A.E.K., L.R.P., Y.W., D.M.L.-J., N.B.A.)
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL (O.R., A.E.K., L.R.P., Y.W., D.M.L.-J., N.B.A.)
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL (O.R., A.E.K., L.R.P., Y.W., D.M.L.-J., N.B.A.)
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Shavarova EK, Khomova IA, Kobalava ZD, Kirpichnikova EI, Ezhova NE, Bazdyreva EI. High normal blood pressure and left ventricular structural and functional disorders in young adults. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2022. [DOI: 10.15829/1728-8800-2022-3282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Aim. To evaluate the association of a high normal blood pressure (BP) with the risk of early hypertension-mediated organ damage (HMOD) in young adults.Material and methods. Medical screening of population aged 18-45 years (n=987) revealed that in 173 persons, office BP corresponded to a high normal level or hypertension (HTN). Echocardiography (GE Healthcare Vivid 9, using EchoPAC Software) was performed when HTN was confirmed by office BP measurement and/or according to 24-hour ambulatory BP monitoring (ABPM) (n=127). In addition, creatinine and albumin-to-creatinine ratio in spot urine were measured.Results. The median age was 23 [21; 25] years. The median systolic (SBP) and diastolic BP (DBP) was 129 [121; 137] and 75±12 mm Hg, respectively. The detection rate of LV geometry abnormalities was 3,3 times higher in the high normal BP group [95% CI, 1,06-6,28, p=0,02], and 10,7 times higher in the HTN group [95% CI, 2,32-16,49, p=0,04] compared with the optimal+normal BP group. In a multivariate analysis, the independence of associations with the LV mass index (LVMI) was confirmed only for the mean nighttime DBP, left atrial volume index, and the ratio of LV peak early diastolic velocity to the average septal and lateral peak early diastolic mitral annular velocity.Conclusion. In young people, the prevalance of HMOD is comparable in the groups with high normal BP and HTN, while significant differences were found between the group with optimal+normal BP levels and patients with HTN and high normal BP. An independent association of elevated LVMI with mean nighttime DBP was found.
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Affiliation(s)
- E. K. Shavarova
- Peoples’ Friendship University of Russia;
V. V. Vinogradov City Clinical Hospital
| | | | | | | | - N. E. Ezhova
- Peoples’ Friendship University of Russia;
V. V. Vinogradov City Clinical Hospital
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