Abstract 08: Heterogeneity in Transitioning from Ideal Blood Pressure Over the Life Course in the US
Introduction: Blood pressure (BP) levels in early life have been shown to predict development of hypertension and cardiovascular disease in later life. Many studies have assessed differences in trajectories of elevated BP from childhood to adulthood, but few have examined gender and racial disparities in the age-specific transition from ideal BP over the life course.
Methods: Following AHA’s Ideal Cardiovascular Health (CVH) criteria for BP, we used the prevalence of ideal (age ≥20, <120/80 mm Hg, untreated; age 16-19, <90th percentile), intermediate (age ≥20, 120 to 139/80 to 89 mm Hg or treated to goal levels; age 16-19, 90th-95th percentile or SBP ≥120 or DBP ≥80 mm Hg) and poor (age ≥20, ≥140/90 mm Hg; age 16-19, >95th percentile) resting BP levels among EA, and AA NHANES participants (2007-2012, n=11,663) to estimate the race, age, and sex-specific probabilities and patterns of transitioning between levels using novel Markov-type transition models. These net transition models were specifically designed to estimate net transition probabilities from cross-sectional data.
Results: At the youngest age studied (16 years), marked differences were observed in the prevalence of ideal BP by gender, with prevalence among women (87%) being considerably higher than among men (64%). At age 16, the proportion of AAs with ideal BP declined by 1.2% (95% CI: 0.9-1.4%) one year later, approximately twice the decline observed in EAs (0.6%, 95% CI: 0.5-0.8%). After age 16, the population with ideal BP continued to decrease, although more rapidly for AAs than EAs and for women compared to men. For example, between ages 16 and 30, the population with ideal BP decreased approximately 2.0% (95% CI: 1.6-2.4%) and 1.0% (95% CI: 0.9-1.5%) per year for AA and EA women, respectively; between 30 and 40 years of age, the annual decline in ideal BP increased to approximately 3.9% (95% CI: 3.2-4.5%) and 2.1% (95% CI: 1.7-2.4%) per year for AA and EA women, respectively. By age 50, decreases in the population with ideal BP began to slow and become more stable for men but continued to decrease for both AA and EA women.
Conclusions: Our results suggest that BP-related disparities emerge during adolescence, by which the decline of ideal BP at age 16 places AAs and men at risk for early, and sustained loss of optimal BP. A focus on early life for primordial prevention to prevent the transition away from ideal BP seems particularly pertinent for AAs and men.
Author Disclosures: S.T. Hardy: None. K.M. Holliday: None. S. Chakladar: None. J.C. Engeda: None. G. Heiss: None. D. Lin: None. C.M. Shay: None. D. Zeng: None. C.L. Avery: None.
- © 2015 by American Heart Association, Inc.