Hypertension Tied to Over One-Third of Population-Attributable CVD Risk in U.S. Black Adults

More than one-third of the population-attributable risk (PAR) of cardiovascular disease  (CVD)in the U.S. black adult population is associated with hypertension, according to a new analysis.

“The prevalence of hypertension and the risk for hypertension-related CVD are high among black adults” the authors wrote in their study. “The PAR accounts for both prevalence and excess risk of disease associated with a risk factor.”

The researchers explored PAR for CVD associated with hypertension in black adults with a prospective cohort study of 12,497 black participants over 21 years of age and with no CVD at baseline who were enrolled in the Jackson Heart Study between 2000 and 2004 (events adjudicated through 2015), and the and the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study from 2003 to 2007 (events adjudicated through 2016). The study authors defined hypertension using the 2017 ACC/AHA blood pressure guideline thresholds. The primary outcomes of interest were PAR for CVD associated with hypertension, which the researchers calculated with multivariate-adjusted hazard ratios for CVD, coronary heart disease, heart failure, and stroke linked with hypertension vs. normal blood pressure.

According to the results, 1,935 of the 12,497 study participants had normal blood pressure, 929 had elevated blood pressure, and 9,633 had hypertension. A total of 1,235 Jackson Heart Study and REGARDS participants experienced a CVD event over 14.3 years of follow-up. The HRs associated with hypertension were 1.91 for CVD, 2.41 for coronary heart disease, 1.52 for heart failure, and 2.20 for stroke (95% CIs for all HRs). Hypertension prevalence was 53.2% among non-Hispanic black individuals, and the PAR linked with hypertension was 32.5% (95% CI, 20.5% to 43.6%) for CVD, 42.7% (95% CI, 24.0% to 58.4%) for coronary heart disease, 21.6% (95% CI, 0.6% to 40.8%) for heart failure, and 38.9% (95% CI, 19.4% to 55.6%) for stroke. The analysis results were published in JAMA Cardiology.

“These findings suggest that a substantial proportion of CVD cases among black individuals are associated with hypertension,” the researchers wrote. “Interventions to maintain normal blood pressure throughout the life course may reduce the incidence of CVD in this population.”