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Original Investigation
April 19, 2017

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

Author Affiliations
  • 1Department of Epidemiology, The University of North Carolina at Chapel Hill
  • 2Department of Biostatistics, The University of North Carolina at Chapel Hill
  • 3Department of Preventive Medicine, Northwestern University, Chicago, Illinois
  • 4Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis
  • 5Department of Nutrition, The University of North Carolina at Chapel Hill
JAMA Cardiol. Published online April 19, 2017. doi:10.1001/jamacardio.2017.0652
Key Points

Question  Does age at transition from ideal blood pressure and prehypertension vary by race/ethnicity and sex?

Findings  A cross-sectional study using Markov modeling indicates that higher net transition probabilities away from ideal blood pressure and prehypertension are observed among African Americans and young men in early life, widening the racial/ethnic and sex disparities observed in the burden of ideal and prehypertension at age 8 years.

Meaning  A focus on primordial prevention in childhood and early adulthood is needed to preempt the development of prehypertension and hypertension, as well as racial/ethnic and sex disparities.

Abstract

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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