Racial Disparity in Cognitive and Functional Disability in Hypertension and All-Cause Mortality

Overview

Journal Am J Hypertens

Publisher Oxford University Press

Specialty Cardiology & Vascular Diseases

Date 2015 Jul 4

PMID 26137951

Citations 20

Authors

Ihab Hajjar

Whitney Wharton

Wendy J Mack

Allan I Levey

Felicia C Goldstein

Affiliations

Soon will be listed here.

Abstract

Background: Subjective cognitive and functional limitations are early markers of future dementia and physical disability. Hypertension may increase the risk of dementia; however, the magnitude and significance of subjective limitations in the hypertensive US population are unknown, particularly in African Americans who bear the greatest burden of hypertension. Our objectives were to assess the prevalence and racial disparity of subjective cognitive and functional limitations and their impact on mortality in the hypertensive US population.

Methods: We analyzed data from the National Health and Nutrition Examination Survey (NHANES) collected between 1999 and 2010 (N = 28,477; 31% with hypertension; 11% African American), which included blood pressure measurement, self-reported cognitive and functional (physical and non-physical) limitations, and all-cause mortality. Complex survey regression models were used.

Results: In the United States, 8% of the hypertensive population reported cognitive and 25% reported functional limitations (vs. 5.7% and 15% respectively in the non-hypertensive population, P < 0.0001). Hypertensive African Americans carried the highest burden of cognitive (11%, P = 0.01) and functional (27%, P = 0.03) limitations compared to non-hypertensive African Americans and to non-African Americans. All-cause mortality was significantly higher in hypertensive individuals who reported cognitive or functional limitations (P < 0.0001 for both) relative to those without either.

Conclusions: The prevalence of cognitive and functional disability is larger in the US hypertensive population compared to the non-hypertensive population. African Americans with hypertension carry a disproportionate burden of these limitations. Individuals with hypertension who report cognitive or functional symptoms have higher all-cause mortality and query about these symptoms should be part of hypertension evaluation.

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References

Hajjar I, Lackland D, Cupples L, Lipsitz L . Association between concurrent and remote blood pressure and disability in older adults. Hypertension. 2007; 50(6):1026-32. PMC: 2424316. DOI: 10.1161/HYPERTENSIONAHA.107.097667. View

Kohler S, Baars M, Spauwen P, Schievink S, Verhey F, van Boxtel M . Temporal evolution of cognitive changes in incident hypertension: prospective cohort study across the adult age span. Hypertension. 2013; 63(2):245-51. DOI: 10.1161/HYPERTENSIONAHA.113.02096. View

Flack J . The epidemiology of hypertension and related conditions in the African-American population. J Natl Med Assoc. 1995; 87(8 Suppl):606-9. PMC: 2607935. View

Post W, Hill M, Dennison C, Weiss J, Gerstenblith G, Blumenthal R . High prevalence of target organ damage in young, African American inner-city men with hypertension. J Clin Hypertens (Greenwich). 2003; 5(1):24-30. PMC: 8101811. DOI: 10.1111/j.1524-6175.2003.01246.x. View

Lee S, Moody-Ayers S, Landefeld C, Walter L, Lindquist K, Segal M . The relationship between self-rated health and mortality in older black and white Americans. J Am Geriatr Soc. 2007; 55(10):1624-9. DOI: 10.1111/j.1532-5415.2007.01360.x. View

Klein R, Schoenborn C . Age adjustment using the 2000 projected U.S. population. Healthy People 2010 Stat Notes. 2001; (20):1-10. View

. Racial/ethnic disparities in self-rated health status among adults with and without disabilities--United States, 2004-2006. MMWR Morb Mortal Wkly Rep. 2008; 57(39):1069-73. View

van Dijk E, Breteler M, Schmidt R, Berger K, Nilsson L, Oudkerk M . The association between blood pressure, hypertension, and cerebral white matter lesions: cardiovascular determinants of dementia study. Hypertension. 2004; 44(5):625-30. DOI: 10.1161/01.HYP.0000145857.98904.20. View

Jessen F, Wiese B, Bachmann C, Eifflaender-Gorfer S, Haller F, Kolsch H . Prediction of dementia by subjective memory impairment: effects of severity and temporal association with cognitive impairment. Arch Gen Psychiatry. 2010; 67(4):414-22. DOI: 10.1001/archgenpsychiatry.2010.30. View

10.

Sheats N, Lin Y, Zhao W, Cheek D, Lackland D, Egan B . Prevalence, treatment, and control of hypertension among African Americans and Caucasians at primary care sites for medically under-served patients. Ethn Dis. 2005; 15(1):25-32. View

11.

Reisberg B, Shulman M, Torossian C, Leng L, Zhu W . Outcome over seven years of healthy adults with and without subjective cognitive impairment. Alzheimers Dement. 2010; 6(1):11-24. PMC: 3873197. DOI: 10.1016/j.jalz.2009.10.002. View

12.

Muller M, van der Graaf Y, Visseren F, Mali W, Geerlings M . Hypertension and longitudinal changes in cerebral blood flow: the SMART-MR study. Ann Neurol. 2012; 71(6):825-33. DOI: 10.1002/ana.23554. View

13.

Batson B, Belletti D, Wogen J . Effect of African American race on hypertension management: a real-world observational study among 28 US physician practices. Ethn Dis. 2011; 20(4):409-15. View

14.

Egan B, Zhao Y, Axon R . US trends in prevalence, awareness, treatment, and control of hypertension, 1988-2008. JAMA. 2010; 303(20):2043-50. DOI: 10.1001/jama.2010.650. View

15.

Johnson C, Paulose-Ram R, Ogden C, Carroll M, Kruszon-Moran D, Dohrmann S . National health and nutrition examination survey: analytic guidelines, 1999-2010. Vital Health Stat 2. 2014; (161):1-24. View

16.

Hausdorff J, Herman T, Baltadjieva R, Gurevich T, Giladi N . Balance and gait in older adults with systemic hypertension. Am J Cardiol. 2003; 91(5):643-5. DOI: 10.1016/s0002-9149(02)03332-5. View

17.

Demirovic J, Prineas R, Loewenstein D, Bean J, Duara R, Sevush S . Prevalence of dementia in three ethnic groups: the South Florida program on aging and health. Ann Epidemiol. 2003; 13(6):472-8. DOI: 10.1016/s1047-2797(02)00437-4. View

18.

Pinsky J, Branch L, Jette A, Haynes S, Feinleib M, Bailey K . Framingham Disability Study: relationship of disability to cardiovascular risk factors among persons free of diagnosed cardiovascular disease. Am J Epidemiol. 1985; 122(4):644-56. DOI: 10.1093/oxfordjournals.aje.a114144. View

19.

Faraco G, Iadecola C . Hypertension: a harbinger of stroke and dementia. Hypertension. 2013; 62(5):810-7. PMC: 3847558. DOI: 10.1161/HYPERTENSIONAHA.113.01063. View

20.

Morillas P, de Andrade H, Castillo J, Quiles J, Bertomeu-Gonzalez V, Cordero A . Inflammation and apoptosis in hypertension. Relevance of the extent of target organ damage. Rev Esp Cardiol (Engl Ed). 2012; 65(9):819-25. DOI: 10.1016/j.recesp.2012.03.020. View