Reeves Alexis N, Odden Michelle C
Epidemiology and Population Health, Stanford University, Stanford, California, USA.
Epidemiology and Population Health, Stanford University, Palo Alto, California, USA.
BMJ Public Health. 2025 Mar 28;3(1):e001993. doi: 10.1136/bmjph-2024-001993. eCollection 2025 Jan.
Racially minoritised populations, particularly Black individuals, have been shown to have an earlier average age of onset of hypertension (elevated systolic and/or diastolic blood pressure) compared with White individuals potentially due to 'weathering' or accelerated health declines due to the cumulative impact of marginalisation over the lifecourse. Systolic blood pressure is more reactive to stress, increases linearly with age indicative of arterial ageing and is more highly associated with cardiovascular morbidity and mortality versus diastolic blood pressure. However, little research has examined racial differences in isolated systolic hypertension. This study examines the race/gender differences in the prevalence of two mutually exclusive manifestations of hypertension: diastolic hypertension (ie, elevated diastolic with or without elevated systolic blood pressure) and isolated systolic hypertension (increased systolic only) over the lifecourse.
The National Health and Nutrition Examination Survey from 2016 to 2020, a US-based population representative cross-sectional study, was used in weighted multinomial logistic regression models to estimate age-specific prevalence of hypertension subtypes by race/gender subgroups controlling for socioeconomic status and anti-hypertensive use. Outcomes were diastolic (diastolic ≥90 mm Hg with/without systolic ≥140 mm Hg) and isolated systolic (systolic ≥140 mm Hg and diastolic <90 mm Hg) hypertension.
The prevalence of diastolic hypertension increased until midlife and then decreased with increasing age, while the prevalence of isolated systolic hypertension increased throughout the lifecourse. Black women had nearly triple the prevalence of diastolic hypertension from 20 to 45 years where the disparity lessens to double the prevalence and continues to lessen with increasing age and 2-3 times the prevalence of isolated systolic hypertension as early as 35 years with continued disparity at older ages. Black men had nearly double the prevalence of diastolic hypertension from 35 to 65 years and at least double the prevalence of isolated systolic hypertension throughout the lifecourse with the widest disparities at 40 years. Disparities attenuated but remained statistically significant with adjustment for socioeconomic status.
Results suggest that isolated systolic hypertension is a dominant and important form of hypertension starting in midlife (~50-60 years); however, indicative of potential earlier arterial ageing, Black men and women's increased prevalence may start as early as 35 and 45 years, respectively.
与白人相比，少数族裔人群，尤其是黑人，高血压（收缩压和/或舒张压升高）的平均发病年龄更早，这可能是由于“健康损耗”或因一生中边缘化的累积影响导致健康加速衰退。收缩压对应激更敏感，随年龄呈线性增加，表明动脉老化，并且与心血管疾病的发病率和死亡率的关联比舒张压更强。然而，很少有研究探讨单纯收缩期高血压的种族差异。本研究考察了一生中高血压两种相互排斥表现形式的患病率的种族/性别差异：舒张期高血压（即舒张压升高，无论收缩压是否升高）和单纯收缩期高血压（仅收缩压升高）。
使用2016年至2020年的美国国家健康与营养检查调查（一项基于美国人群的代表性横断面研究），通过加权多项逻辑回归模型，在控制社会经济地位和抗高血压药物使用的情况下，按种族/性别亚组估计高血压亚型的年龄特异性患病率。结局指标为舒张期高血压（舒张压≥90mmHg，无论收缩压是否≥140mmHg）和单纯收缩期高血压（收缩压≥140mmHg且舒张压<90mmHg）。
舒张期高血压的患病率在中年之前上升，然后随年龄增长而下降，而单纯收缩期高血压的患病率在一生中持续上升。黑人女性在20至45岁时舒张期高血压的患病率几乎是白人女性的三倍，这种差距在随后逐渐减小至两倍，并且随着年龄的进一步增长持续减小；而早在35岁时，黑人女性单纯收缩期高血压的患病率就是白人女性的2至3倍，并且在老年时差距依然存在。黑人男性在35至65岁时舒张期高血压的患病率几乎是白人男性的两倍，并且在一生中单纯收缩期高血压的患病率至少是白人男性的两倍，在40岁时差距最大。在对社会经济地位进行调整后，种族差距有所减小，但仍具有统计学意义。
结果表明，单纯收缩期高血压是从中年（约50 - 60岁）开始的一种主要且重要的高血压形式；然而，这表明可能存在更早的动脉老化，黑人男性和女性患病率的增加可能分别早在35岁和45岁就开始了。
