Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA.
Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
J Hum Hypertens. 2023 Dec;37(12):1112-1118. doi: 10.1038/s41371-023-00842-w. Epub 2023 Jul 5.
Higher rates of cardiovascular events have been observed among rural residents compared with urban. Hypertension and lack of blood pressure (BP) control are risk factors for cardiovascular events. We compared the prevalence of hypertension and controlled BP, and the distribution of systolic blood pressure (SBP), by urban-rural residence. Participants from the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study, a prospective cohort of Black and White adults aged ≥45 years, were categorized as either urban, large rural, or small-isolated rural, by using the Rural-Urban Commuting Area (RUCA) categorization B system. Oucomes were hypertension prevalence (BP ≥ 140/90 mmHg or antihypertensive use), BP control (BP < 140/90 among participants on antihypertensive medication), and the distribution of SBP. Counfounders were age, race, sex, antihypertensive medication use, and US Census Bureau division. The analysis included 26,133 participants (80.3% urban, 11.6% large-rural, 8.2% small-isolated rural). The unadjusted prevalence of hypertension was not different between groups. However, after adjustment, the odds of hypertension was higher among participants in the large rural group (odds ratio [OR] 1.17; 95% confidence interval [CI], 1.08-1.27) and small-isolated rural group (OR 1.19; 95% CI, 1.08-1.30), compared with the urban group. There was no evidence of an adjusted difference in BP control for those taking antihypertensive medications. Adjusted differences in SBP were greater for both rural groups, compared with urban, at the higher percentiles of SBP. Rural residence was associated with a higher adjusted odds of hypertension and higher SBP.
与城市居民相比，农村居民的心血管事件发生率更高。高血压和血压控制不佳是心血管事件的危险因素。我们比较了城乡居民高血压和血压控制的患病率，以及收缩压（SBP）的分布情况。来自 Reasons for Geographic And Racial Differences in Stroke（REGARDS）研究的参与者，是一项针对年龄≥45 岁的黑人和白人成年人的前瞻性队列研究，根据 Rural-Urban Commuting Area（RUCA）分类 B 系统，将参与者分为城市、大农村或小孤立农村。结局为高血压患病率（BP≥140/90mmHg 或使用降压药）、血压控制（服用降压药的患者 BP＜140/90mmHg）和 SBP 分布情况。混杂因素为年龄、种族、性别、使用降压药和美国人口普查局分区。该分析共纳入 26133 名参与者（80.3%为城市居民，11.6%为大农村居民，8.2%为小孤立农村居民）。未经调整时，各组间高血压的患病率无差异。然而，调整后，大农村组（比值比 [OR] 1.17；95%置信区间 [CI]，1.08-1.27）和小孤立农村组（OR 1.19；95% CI，1.08-1.30）的高血压患病风险高于城市组。服用降压药的患者中，血压控制的调整差异无统计学意义。与城市组相比，农村组的 SBP 调整差异在较高的 SBP 百分位数时更大。农村居住与调整后高血压的患病风险增加和 SBP 升高相关。
