Racial Disparities in Blood Pressure Control and Implications of Hypertension Guidelines

This dissertation examines key issues for improving hypertension management and the implications of recent guidelines for cardiovascular health and disparities. We used multiple data sources and study designs to inform our public health recommendations. First, we examined trends in hypertension awareness, treatment, and control from 1999 to 2016 using National Health and Nutrition Examination Survey (NHANES) data. Awareness, treatment, and control increased overall, but primarily between 1999 and 2010. Hypertension treatment to control was lower among Blacks than whites. There were gaps at all stages of care among younger Hispanics. Second, clinical guidelines emphasize accurate blood pressure (BP) measurement for hypertension diagnosis and treatment. Rounding measurements to zero is a common source of error. We used National Disease and Therapeutic Index data from 2014 to 2018 to examine BP measurements at physician office visits by adults aged ≥18 with treated hypertension. The proportion of measurements ending in zero remains high, despite modest decreases among systolic (43.0% to 38.1%) and diastolic (44.3% to 39.4%) BP measurements. Third, we examined changes in hypertension control from 2011-2013 to 2016-2017 among white and Black older adults with treated hypertension in the Atherosclerosis Risk in Communities Study. At baseline, 75.4% of whites and 66.0% of Blacks had controlled hypertension. While changes were similar by race, Blacks with diabetes or reduced kidney function were less likely to be controlled at follow up. Higher BP goals recommended in 2014 for older adults and those with diabetes and chronic kidney disease may contribute to these findings and differences by race. Finally, we calculated the proportion of cardiovascular events which could be prevented if hypertension was treated to the 2017 guideline target (