Ann Arbor VA Healthcare System, Departments of Medicine and Neurology, University of Michigan, Ann Arbor, Mich 48109, USA.
Hypertension. 2011 Jan;57(1):39-47. doi: 10.1161/HYPERTENSIONAHA.110.160341. Epub 2010 Dec 6.
Although the variability of cardiovascular disease mortality by geography, race, and sex is well known, less is known about risk factor variation. We assessed 20-year incidence of hypertension, a cardiovascular disease risk factor, across 4 US urban areas and by race-sex. Among 3436 eligible adults 18 to 30 years of age when recruited in 1985 to 1986 in the community-based Coronary Artery Risk Development in Young Adults (CARDIA) cohort, we examined 20-year cumulative incidence of hypertension (systolic blood pressure ≥ 140 mm Hg or diastolic blood pressure ≥ 90 mm Hg or antihypertensive medication use at any examination) by site and race-sex, adjusting for baseline and time-dependent covariates with Cox regression. Twenty-year incidence, when the mean age was ≈ 45 years, was 34.5% in black men (n = 617), 37.6% in black women (n = 965), 21.4% in white men (n = 856), and 12.3% in white women (n = 998; P<0.001). Incidence was 33.6% in Birmingham, Ala, 23.4% in Chicago, Ill, 19% in Minneapolis, Minn, and 27.4% in Oakland, Calif (P<0.001). After adjustment for age, race, sex, heart rate, body mass index, smoking, family history, education, uric acid, alcohol use, physical activity, and baseline systolic blood pressure, hazard ratios (95% CI) compared with Birmingham were 0.72 (0.59 to 0.87) for Chicago, 0.60 (0.50 to 0.74) for Minneapolis, and 0.73 (0.61 to 0.87) for Oakland. Race-sex differences persisted after adjustment for site, especially for black women. From young adulthood to middle age, hypertension incidence varies significantly across urban areas. Independent of geography, blacks, especially women, are at markedly higher risk of hypertension. Hypertension incidence may contribute to geographic and racial differences in cardiovascular disease mortality, including stroke.
虽然心血管疾病死亡率的地理、种族和性别差异是众所周知的，但风险因素的变化却知之甚少。我们评估了 4 个美国城市地区和不同种族-性别群体的 20 年高血压发病率，高血压是心血管疾病的一个风险因素。在 1985 年至 1986 年以社区为基础的年轻人冠状动脉风险发展（CARDIA）队列中，共有 3436 名 18 至 30 岁的合格成年人参与，我们通过地点和种族-性别检查了 20 年的高血压累积发病率（收缩压≥140mmHg 或舒张压≥90mmHg 或任何检查时使用抗高血压药物），并使用 Cox 回归调整了基线和随时间变化的协变量。当平均年龄约为 45 岁时，黑人男性（n=617）的 20 年发病率为 34.5%，黑人女性（n=965）为 37.6%，白人男性（n=856）为 21.4%，白人女性（n=998）为 12.3%（P<0.001）。发病率在阿拉巴马州伯明翰为 33.6%，伊利诺伊州芝加哥为 23.4%，明尼苏达州明尼阿波利斯为 19%，加利福尼亚州奥克兰为 27.4%（P<0.001）。在调整年龄、种族、性别、心率、体重指数、吸烟、家族史、教育程度、尿酸、饮酒、体力活动和基线收缩压后，与伯明翰相比，芝加哥的危险比（95%CI）为 0.72（0.59 至 0.87），明尼阿波利斯为 0.60（0.50 至 0.74），奥克兰为 0.73（0.61 至 0.87）。调整地点后，种族-性别差异仍然存在，尤其是黑人女性。从年轻成年到中年，高血压发病率在城市地区差异显著。独立于地理位置，黑人，尤其是女性，患高血压的风险明显更高。高血压发病率可能导致心血管疾病死亡率的地理和种族差异，包括中风。
