Hypertension Prevalence and Treatment Among Middle-Aged Adults

Statistics show that 116 million adults in the United States have hypertension, also known as high blood pressure. There are various modifiable risk factors for cardiovascular disease— smoking, diabetes, high cholesterol, obesity, physical inactivity, and poor nutrition to name a few—but hypertension is considered the top one.^1,2

Also, hypertension in middle-aged adults (those 35-50 years of age) is reportedly associated with “poor cardiovascular health in subsequent decades. ”.³ As a result, in a cross-sectional study published in JAMA Network Open,¹ investigators sought to figure out and understand how hypertension differs by race and ethnicity across various levels of neighborhood socioeconomic position.

Between the Aug. 7, 2023, and June 1, 2024 timeframe, the investigators examined electronic health record (EHR) data of adults aged 35 to 50 years who lived in Cuyahoga County, OH, and had one or more primary care appointments within the Cleveland Clinic Health System or MetroHealth System in the year 2019. Geocoded EHR data were then linked to the area deprivation index (ADI), which is a neighborhood disadvantage measure, at the US Census Block Group level (such as by neighborhood).

The total sample size consisted of 56,387 adults (median [IQR] age, 43.1 [39.1-46.9] years; 59.8% female) spanning 1,157 neighborhoods. Overall, this included 3.4% Asian, 5.5% Hispanic, 31.1% Black, and 60.0% White patients being evaluated. The study authors observed a gradient of hypertension prevalence, consisting of the highest versus lowest ADI quintile neighborhoods having a higher hypertension rate (50.7% vs 25.5%) and a lower treatment rate (61.3% vs 64.5%).

Out of the 315 neighborhoods containing mostly Black (>75%) patient populations, 200 (63%) had a hypertension rate greater than 35% combined with a treatment rate of less than 70%; this means that 31 of 263 neighborhoods (11.8%) making up 5% or less Black patient populations met this same benchmark. When compared alongside a spatial model without covariates, inclusion of ADI and proportion of Black patients comprised 91% of variation in hypertension diagnosis prevalence among men, and 98% among women. Men therefore presented a greater prevalence of hypertension than women across race and ADI quintiles, but the association of ADI and hypertension risk was stronger in women. Sex prevalence differences were smallest between Black men and women, particularly in the highest ADI quintile (1689 [60.0%] and 2592 [56.0%], respectively).

However, it’s important to note that the study does present various limitations, including that the population is only limited to patients who actually engage with the healthcare system and utilize the primary care services. This means that the above hypertension estimates only represents the people who accessed care.

Given these results, the investigators concluded that, “The findings of this cross-sectional study suggest stark racial and neighborhood disparities in hypertension prevalence and antihypertensive treatment among adults in midlife, with a significant burden of undertreated hypertension in socioeconomically disadvantaged and racially segregated communities. Using spatial analysis techniques to identify neighborhoods in need, future research might investigate structural interventions to address place-based hypertension disparities.”

References

1. Blazel MM, Perzynski AT, Gunsalus PR, et al. Neighborhood-Level Disparities in Hypertension Prevalence and Treatment Among Middle-Aged Adults. JAMA Netw Open. 2024;7(8):e2429764. doi:10.1001/jamanetworkopen.2024.29764

2. Cardiovascular Disease Risk Factors. Illinois Department of Public Health. Accessed September 11, 2024. http://www.idph.state.il.us/heartstroke/cvd_rf.htm#:~:text=The%20more%20risk%20factors%20a,physical%20inactivity%20and%20poor%20nutrition.

3. Liu EF, Rubinsky AD, Pacca L, et al. Examining neighborhood socioeconomic status as a mediator of racial/ethnic disparities in hypertension control across two San Francisco health systems. Circ Cardiovasc Qual Outcomes. 2022;15(2):e008256. doi:10.1161/CIRCOUTCOMES.121.008256