Prevalence of Hypertension in the U.S. Adults: Age, Sex, Marital Status, and Ethnic Differences

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Prevalence of Hypertension in the U.S. Adults: Age, Sex, Marital Status, and Ethnic Differences

https://doi.org/10.21203/rs.3.rs-1654042/v2

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Hypertension is the most common modifiable risk factor for cardiovascular disease associated with significant morbidity and mortality. Up-to-date prevalence data on hypertension provide the foundation for informing population research, education, and health policy. We sought to determine differences in the prevalence of hypertension in the U.S. population according to age, sex, ethnicity, and marital status.We performed an observational, cross-sectional study using a nationally representative sample of the US civilian noninstitutionalized population 2013 through 2018 National Health and Nutritional Examination Survey (NHANES) to determine hypertension prevalence rates.A total of 7458 participants had hypertension. The weighted prevalence of hypertension among US adults ages 18 years and older was 39.5% (95% CI, 37.10–41.89%), which represented an estimated 92.4 million persons in the United States. black participants 47.65% (CI, 45.57 to 49.73), white 40.97% (38.94 to 43.00), other racial 35.14% (31.87 to 38.42), and Hispanic 29.87% (27.60 to 32.13). Across ethnic groups, males were more likely to have hypertension, except black participants. The prevalence of hypertension increased with age. Persons with > = 75 years: OR 13.82(95%CI 11.56–16.52); male: OR 1.29(95%CI 1.17–1.42); separated: OR 1.74(95%CI 1.43–2.10) had higher rates of hypertension when compared to lowest categories.As prevalence of hypertension in the US are rising, with age, sex, marital status, and racial/ethnic minority individuals being disproportionately impacted by hypertension, targeted public health efforts may reduce health disparities and decrease the overall population burden of hypertension.

hypertension

epidemiology

National Health and Nutrition Examination Survey

prevalence

US adults

Hypertension is the most common modifiable risk factor for cardiovascular disease, the leading cause of death worldwide¹. In 2015, the estimated number of deaths that were associated with hypertension was 7.8 million, accounting for 14% of all deaths². It is the leading cause of morbidity and mortality in the United States and generates>51.2 billion dollars in healthcare costs annually². Thus, identifying relevant risk factors of hypertension is of utmost importance in designing effective prevention strategies and hypertension treatment programs. Although, the prevalence of hypertension in different ages, genders, races and marital status has been reported in the United States^{3, 4}. Nevertheless, the prevalence of hypertension varies among different studies^{5, 6}. It was not detailed what the prevalence of hypertension was under different combinations of age, sex, race, and marital status.

This study used data from the National Health and Nutrition Survey (NHANES) from 2013 to 2018 to reveal differences in the prevalence of hypertension in the United States among age groups, genders, races, and marital status. And the prevalence of hypertension under the above different combinations.

The 17 045 NHANES participants with valid data represented 234.1 million non-institutionalized residents of the United States. Among 916 participants with missing data, 27% were white, 21% were black, 33% were Hispanic, and 19% were Others; female accounted for 52%, male accounted for 48%. A total of 7458 participants had hypertension. The weighted prevalence was 39.5% (95% CI, 37.10–41.89%), which represented an estimated 92.4 million persons in the United States. hypertension patients were older, more commonly male, black participant and had higher separated (Table 1).

Table 1

Nationally Representative Population-Weighted Descriptive Statistics of U.S. Adults by Hypertension Status, NHANES (2013–2018)
Variable	No Hypertension N = 141621432 (60.5%)¹	Hypertension N = 92441070 (39.5%)¹	p-value²
Age,y	41.6 (15.4)	57.6 (15.2)	< 0.001
Age group,y			< 0.001
18–44	85,530,377 (60.4%)	19,140,248 (20.7%)
45–54	24,816,137 (17.5%)	16,379,986 (17.7%)
55–64	17,776,422 (12.6%)	23,993,523 (26.0%)
65–74	9,306,743 (6.6%)	18,532,311 (20.0%)
>=75	4,191,753 (3.0%)	14,395,002 (15.6%)
Sex			0.013
Female	74,923,907 (52.9%)	46,588,329 (50.4%)
Male	66,697,525 (47.1%)	45,852,742 (49.6%)
Race			< 0.001
black	13,984,566 (9.9%)	12,729,562 (13.8%)
white	88,372,354 (62.4%)	61,339,425 (66.4%)
Hispanic	25,033,842 (17.7%)	10,661,613 (11.5%)
others	14,230,670 (10.0%)	7,710,471 (8.3%)
Marital			< 0.001
never married	33,533,865 (23.7%)	9,846,051 (10.7%)
married and living with partner	89,626,927 (63.3%)	57,581,152 (62.3%)
separated	18,460,641 (13.0%)	25,013,868 (27.1%)
¹Mean (SD); n (%)
²Wilcoxon rank-sum test for complex survey samples; chi-squared test with Rao & Scott's second-order correction

The prevalence of hypertension differed by age, sex, and ethnicity (Fig. 1; Table 2). Hypertension was present in 47.65% (CI, 45.57 to 49.73) of black participants, 40.97% (38.94 to 43.00) of white participants, 35.14% (31.87 to 38.42) of other racial, and 29.87% (27.60 to 32.13) of Hispanic participants. Across ethnic groups, males were more likely to have hypertension: 42.79% (40.31 to 45.26) for white males versus 39.28% (37.00 to 41.56) for white females, 37.24% (33.12 to 41.36) for other racial males versus 33.15% (28.81 to 37.50) for other racial females, and 30.82% (27.79 to 33.86) for Hispanic males versus 28.93% (26.26 to 31.60) for Hispanic females, except black participants,46.17% (43.27 to 49.07) for black males versus 48.85% (46.33 to 51.38) for black females. The prevalence of hypertension increased with age. For every racial and sex category, a similar pattern of increasing prevalence of hypertension by age was observed, except ,75 year and older other racial female participants. For every age and sex category, black participants were more likely than white, Hispanic, and other racial participants to have hypertension; in most age group and males categories, hypertension was less common among Hispanic participants than among white, black, and other racial participants; in most age group and females categories, hypertension was less common among white participants than among black, Hispanic, and other racial participants.

Table 2

Percentage of Male and Female Participants with Hypertension
Sex and Age Group	Participants, n (%) [95% CI]
Males	Black	White	Hispanic	Others
18–44	176(25.00)[21.40-28.59]	264(23.10)[20.17–26.03]	155(19.02)[15.69–22.36]	126(19.57)[16.20-22.94]
45–54	149(54.78)[49.50-60.06]	195(42.43)[36.23–48.63]	115(35.54)[29.48–41.59]	98(36.56)[27.32–45.79]
55–64	293(75.07)[70.06–80.09]	294(58.75)[53.51-64.00]	234(55.78)[50.00-61.57]	126(62.06)[51.73–72.39]
65–74	212(78.57)[74.43–82.71]	293(60.10)[54.46–65.75]	184(69.00)[63.99–74.01]	105(72.74)[64.02–81.47]
>=75	123(84.03)[78.86–89.19]	402(71.31)[67.17–75.46]	69(70.38)[60.76–80.01]	63(82.25)[71.67–92.83]
Females
18–44	195(23.07)[19.67–26.48]	173(13.76)[11.48–16.04]	136(12.17)[ 9.95–14.40]	75(12.38)[ 8.98–15.79]
45–54	198(60.44)[55.47–65.41]	183(33.62)[28.51–38.74]	145(37.00)[31.79–42.20]	79(36.29)[26.11–46.46]
55–64	301(77.32)[72.41–82.24]	272(50.65)[45.77–55.53]	239(54.58)[48.28–60.88]	136(56.33)[47.85–64.81]
65–74	189(82.55)[77.24–87.86]	317(66.18)[61.49–70.87]	245(72.45)[67.79–77.11]	126(81.83)[75.18–88.48]
>=75	152(92.33)[87.89–96.77]	450(79.57)[75.79–83.35]	110(84.22)[77.38–91.06]	61(73.36)[63.08–83.64]

Multivariate logistic regression analysis was done to estimate the prevalence of hypertension adjusted for age, sex, ethnicity and marital status (Table 3). Compared with black participants, white participants, Hispanic participants and other racial participants were less likely (P < 0.001) to have hypertension. the prevalence of hypertension was significantly higher in separated, and older persons(P < 0.001). Men were more likely to have hypertension than women(P < 0.001).

Table 3

Weighted Prevalence of hypertension by age,sex,ethnicity,and marital status
Variable	Prevalence,%*(95% CI)
Age
18–44	18.29(16.98,19.59)
45–54	39.76(36.77,42.75)
55–64	57.44(54.86,60.03)
65–74	66.57(63.24,69.90)
>=75	77.45(75.01,79.88)
Sex
Female	38.34(36.53,40.15)
Male	40.74(38.94,42.54)
Ethnicity
black	47.65(45.57,49.73)
white	40.97(38.94,43.00)
hispanic	29.87(27.60,32.13)
other	35.14(31.87,38.42)
Marital Status
never married	22.70(20.67,24.72)
married and living with partner	39.12(37.47,40.76)
separated	57.54(54.94,60.14)
* Prevalence is estimated as the predicted marginals in the logistic regression analysis. The estimates for white, black, and Mexican-American participants are adjusted for age and sex.

Table 4 shows the risk factors associated with hypertension in the multivariate logistic regression model. We observed that participants’ sex, age, marital status, and ethnicity appeared to be significant predictors of hypertension in U.S adult. male participants had 1.29 times higher odds (CI 1.17–1.42, p < 0.001) of hypertension compared to their female counterparts. We observed a positive relationship between age and hypertension. The risk of hypertension was 13.82 times (CI 11.56–16.52, p < 0.001) more likely among individuals in > = 75y age group compared to the 18-44y age group. separated had significantly 1.74 times higher odds of being hypertensive compared to respondents who were never married (CI 1.43–2.10, p < 0.001). Individuals Hispanic had 52% lower odds (OR = 0.48, p < 0.001) of suffering from hypertension compared to black counterparts.

Table 4

Weighted logistic regression results between age group,sex, ethnicity,marital status and hypertension (NHANES2013-2018)
Characteristic	OR¹	95% CI¹	p-value
Age(years)			< 0.001
18–44	—	—
45–54	2.77	2.41, 3.20	< 0.001
55–64	5.63	5.01, 6.33	< 0.001
65–74	8.35	7.00, 9.96	< 0.001
>=75	13.82	11.56, 16.52	< 0.001
Sex			< 0.001
Female	—	—
Male	1.29	1.17, 1.42	< 0.001
Race/Ethnicity			< 0.001
black	—	—
white	0.51	0.45, 0.58	< 0.001
hispanic	0.48	0.42, 0.55	< 0.001
others	0.53	0.44, 0.65	< 0.001
Marital status			< 0.001
never married	—	—
married and living with partner	1.26	1.08, 1.49	0.006
separated	1.74	1.43, 2.10	< 0.001
¹OR = Odds Ratio, CI = Confidence Interval

In this study, we report the latest prevalence statistics on hypertension among adults in the United States using NHANES. NHANES is a robust data source for studying disease prevalence because it uses a multistage, stratified survey methodology to obtain prevalence data representative of the general, non-institutionalized US population. The data collected via survey instruments included demographic, socioeconomic, dietary, and health related questions. The oversampling of Hispanic persons, non-Hispanic black persons, non-Hispanic Asian persons, and non-Hispanic white and other persons aged 80 years and older were over-sampled ensured enhanced accuracy in determining prevalence rates among underrepresented populations.

Using nationally representative data, we report the prevalence of hypertension in US adult during the years 2013–2018 as 39.5%. Age, sex, racial, and marital status were factors associated with presence of hypertension at 95% CI.

These risk factors have been reported by different studies^7–9 in different areas. Studies done on risk factors of hypertension reported that as age increases, the risk of hypertension increases¹⁰. Similarly, in this study, the likelihood of hypertension increased with advancing age. As age category increased from 18–44 to 45–54, 55–64, 65–74 and > = 75years, the odds of having hypertension increased from 2.77 [ 95% CI 2.47–3.20], 5.63 [ 95% CI 5.01–6.33], 8.35 [ 95% CI 7.00-9.96], and 13.82 [95% CI 11.56–16.52] respectively. This could be due to the biological effect of increased arterial resistance because of arterial thickening at older age¹¹.

Distinct gender differences in the incidence and severity of hypertension were well-established, and hypertension was more common in men than women^{12, 13}. It is evident that hypertension increase with age in both sexes; however, men have higher blood pressure at a younger age than women^{14, 15}. In our study, the prevalence and the number of hypertension are lower in women than in men until age 45years, but increase later in life. The increasing prevalence of hypertension in older women was often explained by hormonal changes after menopause. Estrogen causes endothelial vasodilation via upregulation of the nitric oxide pathway and inhibition or down regulation of sympathetic and renin angiotensin system activity, as well as endothelin production^{16, 17}. In addition to hormonal changes, anatomical and physiological sex differences may contribute to sex differences in hypertension prevalence in old age¹⁸.

Our study supports prior research demonstrating that Black adults have higher hypertension prevalence than White, Hispanic, and other racial adults. Additionally, Black women have the highest prevalence of hypertension, when compared with White, Hispanic, and other racial Americans⁴. Although differences in diet and lifestyle may contribute to this, socioeconomic factors to accessing healthy food, exercise, and quality healthcare likely increase the burden of hypertension among Black Americans^{19, 20}.

Marital status is also known to play an important role in hypertension⁶. This study found that married and separated were more likely to develop hypertension than never married, similar to studies in Ghana²¹. Physiological stress associated with playing important roles in marriage such as caring for children and spouses, increased pressures from making more money and psychological stress from marital discord could negatively impact married subjects health²². Thus these also might bring about a higher odd of hypertension for married people. The stresses associated with a marital breakdown (spousal death, separation or divorce) could precipitate unhealthy lifestyles such as smoking, drinking, less exercise and poor diet and cause unhealthy psychology, e.g., depression. These may, at least partly, explain why those with marital breakdown had a higher risk of hypertension. Allostasis and adaptation are strongly regarded as a determinant of hypertension in literature²³.

Strengths of the present study include that the NHANES database comprises a large, nationally representative sample of the US population over many years. Blood pressure was measured using a standardized approach, minimizing bias by taking the average of 3 consecutive readings obtained under the same conditions. Medical histories were collected by trained examiners using established protocols. Prescription medications were also verified with drug containers, helping to eliminate known biases associated with self-report. Our study also has a few limitations. First, our findings are based on survey data and thus we cannot exclude response bias. Second, the cross-sectional design of NHANES precludes the evaluation of downstream clinical outcomes related to uncontrolled BP. Third, we were unable to evaluate differences in the hypertension cascade among Asian American or Hispanic subgroups, such as Filipino or Indian Americans.

The prevalence of hypertension among the adult population in U.S is high, individual's risk of hypertension rises with age. with men having a higher prevalence than women. Women have a lower prevalence and number of hypertension than men until they are 45 years old, but the number increases later in life. Adult blacks have higher hypertension prevalence than whites, Hispanics, and other racial, especially in black females. Separated and married or living with partner are more likely to develop hypertension than never married people. As prevalence of hypertension in the US are rising, with age, sex, marital status, and racial/ethnic minority individuals being disproportionately impacted by hypertension, targeted public health efforts may reduce health disparities and decrease the overall population burden of hypertension.

Study Population

The National Center for Health Statistics (NCHS), Division of Health and Nutrition Examination Surveys (DHANES), part of the Centers for Disease Control and Prevention (CDC), has conducted a series of health and nutrition surveys since the early 1960's. The NHANES target population is the non-institutionalized civilian resident population of the United States. This study included a 6-year (2013– 2018) sample of adults (aged > = 18 years). During the 2013 to 2018 examinations, Hispanic persons, Non-Hispanic black persons, Non-Hispanic Asian persons, and Non-Hispanic white and other persons aged 80 years and older were over-sampled to ensure accurate estimates for these groups²⁴. Of the 17961 persons 18 year of age or older, 916 had missing marital status values. After 916 missing values were excluded, there were 17045 participants with complete data. This study reports the prevalence of hypertension for five age-groups: 18–44,45–54, 55–64, 65–74 and > = 75 years; four ethnic/racial groups: non-Hispanic white (White), non-Hispanic black (Black), Mexican American and Other Hispanic (Hispanic), and Other Race-Including Multi-Racial (Others); three status of marital: never married, married and living with partner, and separated (include Separated, Divorced, Widowed).

Blood pressure Measures

Blood pressure is measured according to a standardized protocol by a certified examiner as part of a mobile examination centers (MEC) medical interview. After sitting quietly for five minutes, three consecutive BP readings are obtained. If a BP measurement is interrupted or incomplete, a fourth attempt may be made. Participants with any of the following on both arms are excluded from the exam: rashes, gauze dressings, casts, edema, paralysis, tubes, open sores or wounds, withered arms, a-v shunts, and radical mastectomy. BP measurements are taken in the right arm unless specific conditions prohibit the use of the right arm, or, if participants report any reason that the BP measurements should not be taken in the right arm. Prior to BP measurements, upper arm circumference is measured, which is done to guide selection of cuff size. We calculated means of SBP and diastolic blood pressure (DBP) by the following protocol: The diastolic reading with zero is not used to calculate the diastolic average, If all diastolic readings were zero, then the average would be zero, If only one blood pressure reading was obtained, that reading is the average, If there is more than one blood pressure reading, the first reading is always excluded from the average. Hypertension was defined as having at least one of three criteria: self-reported physician diagnosis of hypertension, or self-reported use of hypertension medication, or with mean systolic blood pressures > = 140mmHg and/or with a mean diastolic > = 90mmHg respectively.

Statistical Analyses

All analyses used weighted samples and considered the stratification and clustering of the design to derive estimates that were applicable to the U.S. population. Examination sample weights, which account for the differential probabilities of selection, nonresponse, and noncoverage, were incorporated into the estimation process²⁵. All variance estimates accounted for the complex survey design by using Taylor series linearization. To provide estimates for the entire 6 years, a 6-year, weight variable sample was created by taking one third for the 2-year weight for each person who was sampled in 2013 to 2018. Non-adjusted frequency distribution of hypertension and non-adjusted prevalence of hypertension regarding age groups, sex, ethnicity and marital status were obtained. Logistic regression adjusting for age group, sex, racial, and marital status was then used to generate predictive marginals for having hypertension. All analyses were performed with R software²⁶, version 4.1.3(R Foundation for Statistical Computing), using the “SURVEY” package²⁷, which incorporates the sample design. Statistical tests were considered significant at P < 0.05 (2-tailed). “SURVEY” functions were used to account for the complex survey design.

Data Availability

Publicly available datasets were analyzed in this study. This data can be found here: www.cdc.gov/nchs/nhanes/.

ETHICS STATEMENT

The studies involving human participants were reviewed and approved by the NCHS Ethics Review Board. The patients/participants provided their written informed consent to participate in this study. The authors are accountable for all aspects of the work in

ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). All information from the NHANES program is available and free for public, so the agreement of the medical ethics committee board was not necessary.

Author Contributions

Xian-Jun Wu, Yi-Bin Mei contributed to the study conception and design. Formal analyses were performed by Xian-Jun Wu, Feng Chen. Dong-Li Lin, Ling-Yan Ye, Wu-Gao Liu, Li-Ping Wu were involved in interpreting the data. Writing of the first draft was performed by Xian-Jun Wu. Supervision, funding, manuscript reviewing and editing were performed by Xian-Jun Wu, Yi-Bin Mei. All authors read and approved the final manuscript. All authors take full responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

Conflicts of Interest

The authors declare that they have no competing interest.

Funding

This work was supported by the Project of Zhejiang Provincial Scientific Research Foundation of traditional Chinese Medicine (2020ZB306).

Ahmad A, Oparil S. Hypertension in women: Recent advances and lingering questions. Hypertension. 2017;70:19–26
Mills KT, Stefanescu A, He J. The global epidemiology of hypertension. Nat Rev Nephrol. 2020;16:223–237
Aggarwal R, Chiu N, Wadhera RK, Moran AE, Raber I, Shen C, Yeh RW, Kazi DS. Racial/ethnic disparities in hypertension prevalence, awareness, treatment, and control in the united states, 2013 to 2018. Hypertension. 2021;78:1719–1726
Chobufo MD, Gayam V, Soluny J, Rahman EU, Enoru S, Foryoung JB, Agbor VN, Dufresne A, Nfor T. Prevalence and control rates of hypertension in the USA: 2017–2018. Int J Cardiol Hypertens. 2020;6:100044
Nishi A, Segawa HK, Uematsu H, Dorji N, Wangdi U, Dorjee C, Yangchen P, Kunisawa S, Sakamoto R, Imanaka Y. Gender with marital status, cultural differences, and vulnerability to hypertension: Findings from the national survey for noncommunicable disease risk factors and mental health using who steps in bhutan. Plos One. 2021;16
Li K, Ma X, Yuan L, Ma J. Age differences in the association between marital status and hypertension: A population-based study. J Hum Hypertens. 2021
Aung TNN, Shirayama Y, Moolphate S, Lorga T, Jamnongprasatporn W, Yuasa M, Aung MN. Prevalence and risk factors for hypertension among myanmar migrant workers in thailand. Int J Environ Res Public Health. 2022;19
Olsen MH, Angell SY, Asma S, Boutouyrie P, Burger D, Chirinos JA, Damasceno A, Delles C, Gimenez-Roqueplo A-P, Hering D, López-Jaramillo P, Martinez F, Perkovic V, Rietzschel ER, Schillaci G, Schutte AE, Scuteri A, Sharman JE, Wachtell K, Wang JG. A call to action and a lifecourse strategy to address the global burden of raised blood pressure on current and future generations: The lancet commission on hypertension. The Lancet. 2016;388:2665–2712
Rosengren A, Smyth A, Rangarajan S, Ramasundarahettige C, Bangdiwala SI, AlHabib KF, Avezum A, Bengtsson Boström K, Chifamba J, Gulec S, Gupta R, Igumbor EU, Iqbal R, Ismail N, Joseph P, Kaur M, Khatib R, Kruger IM, Lamelas P, Lanas F, Lear SA, Li W, Wang C, Quiang D, Wang Y, Lopez-Jaramillo P, Mohammadifard N, Mohan V, Mony PK, Poirier P, Srilatha S, Szuba A, Teo K, Wielgosz A, Yeates KE, Yusoff K, Yusuf R, Yusufali AH, Attaei MW, McKee M, Yusuf S. Socioeconomic status and risk of cardiovascular disease in 20 low-income, middle-income, and high-income countries: The prospective urban rural epidemiologic (pure) study. The Lancet Global Health. 2019;7:e748-e760
Kumma WP, Lindtjorn B, Loha E. Prevalence of hypertension, and related factors among adults in wolaita, southern ethiopia: A community-based cross-sectional study. PLoS One. 2021;16:e0260403
McEniery CM, Wilkinson IB, Avolio AP. Age, hypertension and arterial function. Clin Exp Pharmacol Physiol. 2007;34:665–671
Lacruz ME, Kluttig A, Hartwig S, Loer M, Tiller D, Greiser KH, Werdan K, Haerting J. Prevalence and incidence of hypertension in the general adult population: Results of the carla-cohort study. Medicine (Baltimore). 2015;94:e952
Song JJ, Ma Z, Wang J, Chen LX, Zhong JC. Gender differences in hypertension. J Cardiovasc Transl Res. 2020;13:47–54
Bjertness MB, Htet AS, Meyer HE, Htike MM, Zaw KK, Oo WM, Latt TS, Sherpa LY, Bjertness E. Prevalence and determinants of hypertension in myanmar - a nationwide cross-sectional study. BMC Public Health. 2016;16:590
Liew SJ, Lee JT, Tan CS, Koh CHG, Van Dam R, Muller-Riemenschneider F. Sociodemographic factors in relation to hypertension prevalence, awareness, treatment and control in a multi-ethnic asian population: A cross-sectional study. BMJ Open. 2019;9:e025869
Iorga A, Cunningham CM, Moazeni S, Ruffenach G, Umar S, Eghbali M. The protective role of estrogen and estrogen receptors in cardiovascular disease and the controversial use of estrogen therapy. Biol Sex Differ. 2017;8:33
Hay M. Sex, the brain and hypertension: Brain oestrogen receptors and high blood pressure risk factors. Clin Sci (Lond). 2016;130:9–18
Midtbo H, Gerdts E. Sex disparities in blood pressure development: Time for action. Eur J Prev Cardiol. 2022;29:178–179
Carnethon MR, Pu J, Howard G, Albert MA, Anderson CAM, Bertoni AG, Mujahid MS, Palaniappan L, Taylor HA, Jr., Willis M, Yancy CW, American Heart Association Council on E, Prevention, Council on Cardiovascular Disease in the Y, Council on C, Stroke N, Council on Clinical C, Council on Functional G, Translational B, Stroke C. Cardiovascular health in african americans: A scientific statement from the american heart association. Circulation. 2017;136:e393-e423
Muntner P, Abdalla M, Correa A, Griswold M, Hall JE, Jones DW, Mensah GA, Sims M, Shimbo D, Spruill TM, Tucker KL, Appel LJ. Hypertension in blacks: Unanswered questions and future directions for the jhs (jackson heart study). Hypertension. 2017;69:761–769
Nyarko SH. Prevalence and sociodemographic determinants of hypertension history among women in reproductive age in ghana. Int J Hypertens. 2016;2016:3292938
Law RW, Sbarra DA. The effects of church attendance and marital status on the longitudinal trajectories of depressed mood among older adults. Journal of aging and health. 2009;21:803–823
James GD. Ambulatory blood pressure variation: Allostasis and adaptation. Auton Neurosci. 2013;177:87–94
Prevention. CfDCa, Statistics. NCfH. National health and nutrition examination survey data. Hyattsville, MD:U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. 2020;https://wwwn.cdc.gov/nchs/nhanes/analyticguidelines.aspx#analytic-guidelines
National health and nutrition examination survey: Sample design, 2011–2014. US Department of Health and Human Services, Centers for Disease Control and …
Team RC. R: A language and environment for statistical computing. 2013
Lumley T. Survey: Analysis of complex survey samples. Journal of Statistical Software. 2014;09

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