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Heterogeneity in Blood Pressure Transitions Over the Life Course: Age-Specific Emergence of Racial/Ethnic and Sex Disparities in the United States.

Publication ,  Journal Article
Hardy, ST; Holliday, KM; Chakladar, S; Engeda, JC; Allen, NB; Heiss, G; Lloyd-Jones, DM; Schreiner, PJ; Shay, CM; Lin, D; Zeng, D; Avery, CL
Published in: JAMA Cardiol
June 1, 2017

IMPORTANCE: Many studies have assessed racial/ethnic and sex disparities in the prevalence of elevated blood pressure (BP) from childhood to adulthood, yet few have examined differences in age-specific transitions between categories of BP over the life course in contemporary, multiracial/multiethnic populations. OBJECTIVE: To estimate age, racial/ethnic, and sex-specific annual net transition probabilities between categories of BP using Markov modeling of cross-sectional data from the National Health and Nutrition Examination Survey. DESIGN, SETTING, AND PARTICIPANTS: National probability sample (National Health and Nutrition Examination Survey in 2007-2008, 2009-2010, and 2011-2012) of 17 747 African American, white American, and Mexican American participants aged 8 to 80 years. The data were analyzed from September 2014 to November 2015. MAIN OUTCOMES AND MEASURES: Age-specific American Heart Association-defined BP categories. RESULTS: Three National Health and Nutrition Examination Survey cross-sectional samples were used to characterize the ages at which self-reported African American (n = 4973), white American (n = 8886), and Mexican American (n = 3888) populations transitioned between ideal BP, prehypertension, and hypertension across the life course. At age 8 years, disparities in the prevalence of ideal BP were observed, with the prevalence being lower among boys (86.6%-88.8%) compared with girls (93.0%-96.3%). From ages 8 to 30 years, annual net transition probabilities from ideal to prehypertension among male individuals were more than 2 times the net transition probabilities of their female counterparts. The largest net transition probabilities for ages 8 to 30 years occurred in African American young men, among whom a net 2.9% (95% CI, 2.3%-3.4%) of those with ideal BP transitioned to prehypertension 1 year later. Mexican American young women aged 8 to 30 years experienced the lowest ideal to prehypertension net transition probabilities (0.6%; 95% CI, 0.3%-0.8%). After age 40 years, ideal to prehypertension net transition probabilities stabilized or decreased (range, 3.0%-4.5%) for men, whereas net transition probabilities for women increased rapidly (range, 2.6%-13.0%). Mexican American women exhibited the largest ideal to prehypertension net transition probabilities after age 60 years. The largest prehypertension to hypertension net transition probabilities occurred at young ages in boys of white race/ethnicity and African Americans, approximately age 8 years and age 25 years, respectively, while net transition probabilities for white women and Mexican Americans increased over the life course. CONCLUSIONS AND RELEVANCE: Heterogeneity in net transition probabilities from ideal BP emerge during childhood, with associated rapid declines in ideal BP observed in boys and African Americans, thus introducing disparities. Primordial prevention beginning in childhood and into early adulthood is necessary to preempt the development of prehypertension and hypertension, as well as associated racial/ethnic and sex disparities.

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Published In

JAMA Cardiol

DOI

EISSN

2380-6591

Publication Date

June 1, 2017

Volume

2

Issue

6

Start / End Page

653 / 661

Location

United States

Related Subject Headings

  • Young Adult
  • White People
  • United States
  • Sex Factors
  • Prehypertension
  • Middle Aged
  • Mexican Americans
  • Markov Chains
  • Male
  • Hypertension
 

Citation

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Hardy, S. T., Holliday, K. M., Chakladar, S., Engeda, J. C., Allen, N. B., Heiss, G., … Avery, C. L. (2017). Heterogeneity in Blood Pressure Transitions Over the Life Course: Age-Specific Emergence of Racial/Ethnic and Sex Disparities in the United States. JAMA Cardiol, 2(6), 653–661. https://doi.org/10.1001/jamacardio.2017.0652
Hardy, Shakia T., Katelyn M. Holliday, Sujatro Chakladar, Joseph C. Engeda, Norrina B. Allen, Gerardo Heiss, Donald M. Lloyd-Jones, et al. “Heterogeneity in Blood Pressure Transitions Over the Life Course: Age-Specific Emergence of Racial/Ethnic and Sex Disparities in the United States.JAMA Cardiol 2, no. 6 (June 1, 2017): 653–61. https://doi.org/10.1001/jamacardio.2017.0652.
Hardy ST, Holliday KM, Chakladar S, Engeda JC, Allen NB, Heiss G, et al. Heterogeneity in Blood Pressure Transitions Over the Life Course: Age-Specific Emergence of Racial/Ethnic and Sex Disparities in the United States. JAMA Cardiol. 2017 Jun 1;2(6):653–61.
Hardy, Shakia T., et al. “Heterogeneity in Blood Pressure Transitions Over the Life Course: Age-Specific Emergence of Racial/Ethnic and Sex Disparities in the United States.JAMA Cardiol, vol. 2, no. 6, June 2017, pp. 653–61. Pubmed, doi:10.1001/jamacardio.2017.0652.
Hardy ST, Holliday KM, Chakladar S, Engeda JC, Allen NB, Heiss G, Lloyd-Jones DM, Schreiner PJ, Shay CM, Lin D, Zeng D, Avery CL. Heterogeneity in Blood Pressure Transitions Over the Life Course: Age-Specific Emergence of Racial/Ethnic and Sex Disparities in the United States. JAMA Cardiol. 2017 Jun 1;2(6):653–661.

Published In

JAMA Cardiol

DOI

EISSN

2380-6591

Publication Date

June 1, 2017

Volume

2

Issue

6

Start / End Page

653 / 661

Location

United States

Related Subject Headings

  • Young Adult
  • White People
  • United States
  • Sex Factors
  • Prehypertension
  • Middle Aged
  • Mexican Americans
  • Markov Chains
  • Male
  • Hypertension