Modifiable Risk Factors Associated with Hypertension in Women 50 Years and Older: Results from the 2005 Los Angeles County Health Survey. V Lousuebsakul, Y Du, S Baldwin. Office of Health Assessment and Epidemiology, Los Angeles County Department of Public Health, Los Angeles, California.

To assess the burden of hypertension among older women in Los Angeles County, California.

To examine the association between sociodemographic and lifestyle factors and hypertension in our local population.

Smoking:In our population, we did not observe a harmful effect of smoking on the odds of hypertension (OR=0.95: 95%CI: 0.68-1.31).

Nutrition:We did not observe a protective effect of consuming five or more servings of fruits and vegetables daily on the odds of having hypertension (OR=1.1: 95%CI: 0.85-1.41).

In Los Angeles County, hypertension remains a public health challenge. Disparities in hypertension prevalence due to race and socioeconomic status emphasize the necessity of increasing awareness of the disease, including its prevention and management. Fortunately, many risk factors for hypertension such as obesity, physical activity, alcohol consumption, smoking and dietary habits can be modified by adopting a healthy lifestyle.

ConclusionsThe prevalence of hypertension in this study was obtained by self-report, through a questionnaire. However, one-third of people with hypertension are unaware of their condition5. The cross-sectional nature of this study does not allow one to establish a cause and effect between risk factors and disease.The survey sample was limited to respondents living in households; women in nursing homes were excluded. Survey respondents were also limited to those women who have home telephone.

Limitations References

1. Hajjar I, Kotchen TA. Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988-2000. JAMA. 2003;290:199-206.

2. Oparil S. Women and Hypertension. What Did We Learn from the Women’s Health Initiative? Cardiology in Review. 2006;14:267-275.

3. Whelton SP, Chin A, Xin X, He J. Effects of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials. Ann Intern Med 2002: 136:493-503.

4. Puddey IB, Beilin LJ. Alcohol is bad for blood pressure. Clin Exp Pharmacol Physiol. 2006; 33(9):847-852.

5. National high Blood Pressure Education Program. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC VII), 2003. U.S. Department of Health and Human Services; National Institutes of Health; National Heart, Lung, and Blood Institute. NIH Publication No. 03-5233.

We analyzed data from the Los Angeles County Health Survey, which is a periodic, population-based, random-digit-dialed telephone survey that collects self-reported information on sociodemographic characteristics, health status, health behaviors, and access to health services among adults and children in the county.

Survey respondents included 1,811 women 50 years or older representing 1,341,000 women in the county.

Multivariate logistic regression was used to determine the association between sociodemographic and lifestyle factors and hypertension.

Methods

Key Findings and ImplicationForty-six percent or an estimated 621,000 women reported being diagnosed with hypertension.

As age increased, the odds of having hypertension significantly increased (p < 0.001 for trend test) . In other population samples (NHANES1, WHI2), the age-related increase in the prevalence of hypertension has been observed as well .

Racial/ ethnic disparities in the prevalence of hypertension remain a challenge in Los Angeles County. The odds of having hypertension were highest among African-Americans and lowest among Asians/ Pacific Islanders.

As education and household incomes increase, the odds of having hypertension decrease (p < 0.001 for age-adjusted trend test) . Higher socioeconomic status may imply several factors, including awareness of a healthy lifestyle.

Obesity is a modifiable risk factor of hypertension. Weight reduction is an important step in managing and preventing hypertension.

Previous studies have shown that regular aerobic exercise can reduce blood pressure3. Also, people who are physically active tend to pursue a healthy lifestyle in general, and in doing so reap health benefits.

Consistent with the findings from WHI2, the protective effect of alcohol consumption against hypertension was also observed among “moderate drinkers” in our population. The association between moderate alcohol consumption and hypertension is not well defined.4

Study Goals

Population CharacteristicsAge Distribution Race/ Ethnicity Distribution Education

DistributionHousehold Income Distribution

Multivariate Logistic Regression Model* for Hypertension Among Women 50 Years and Older

51.6%(n=511)

30.9%(n=253) 25.6%

(n=254)

31.6%(n=259)

15.1%(n=150)

25.4%(n=208)

7.7%(n=76)

12.2%(n=100)

0%

10%

20%

30%

40%

50%

60%

Hypertensive Non-hypertensive

50-5

9

60-6

9

70-7

9

80+ 50

-59

60-6

9

70-7

9

80+

P < .0001

18.6%(n=176)

22.2%(n=176)

59.6%(n=563)

54.3%(n=430) 8.5%

(n=80)14.9%(n=118)

13.2%(n=125)

8.6%(n=68)

0%

10%

20%

30%

40%

50%

60%

70%

Hypertensive Non-hypertensive

Lat

ino

Wh

ite

Afr

ica

n-A

mer

ican

As

ian

/ P

acif

ic I

sla

nd

er

Lat

ino

Wh

ite

Afr

ica

n-A

mer

ican

As

ian

s/ P

aci

fic

Isla

nd

er

P < .0001

13.4%(n=132)

20.7%(n=170)

15.7%(n=155)

21.8%(n=179)

29.4%(n=290)

29.9%(n=245)

41.5%(n=409)

27.6%(n=226)

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Hypertensive Non-hypertensive

Les

s th

an

Hig

h S

cho

ol

Hig

h S

cho

ol

So

me

Co

lleg

e

Co

lleg

e/ P

ost

gra

du

ate

Les

s th

an

Hig

h S

cho

ol

Hig

h S

cho

ol

So

me

Co

lleg

e

Co

lleg

e/ P

ost

gra

du

ate

P < .0001

11.1%(n=110)

16.8%(n=138)

19.9%(n=197)

26.1%(n=214) 21.3%

(n=211)22.8%(n=187)

47.7%(n=473)

34.3%(n=281)

0%

10%

20%

30%

40%

50%

60%

Hypertensive Non-hypertensive

0-99

% F

PL

100

%-1

99%

FP

L

200

%-2

99%

FP

L

300

% o

r ab

ove

FP

L

0-99

% F

PL

100

%-1

99%

FP

L

200

%-2

99%

FP

L

300

% o

r ab

ove

FP

L

P < .0001

1.572.06 2.00

2.57

3.63

4.26

2.922.732.01

0

1

2

3

4

5

60-69 years 70-79 years 80+ years

Odds Ratio

*Adjusted for race, income, education, physical activity, obesity, alcohol consumption, smoking, fruit and vegetable consumption

Reference: 50-59 years

AGE

0.630.51 0.43

1.060.92

1.32

0.630.91

0.74

0

1

2

High school Some college/Trade school

College/ Postgraduatedegree

Odds Ratio

*Adjusted for age, race, income, physical activity, obesity, smoking, alcohol consumption, fruit and vegetable consumption

Reference: Less than high school

0.63 0.68

2.5

0.99

0.79

1.3

0

1

2

3

Occasional Drinker Chronic Drinker

Odds Ratio

*Adjusted for age, race, income, education, physical activity, obesity, smoking, fruit and vegetable consumption

† 60 or more alcoholic drinks in the past month

# 1-59 alcoholic drinks in the past month

# †

Reference: Non-drinker

ALCOHOL CONSUMPTION

1.17

1.641.9

2.86

2.161.49

0

1

2

3

4

Overweight Obesity

Odds Ratio

*Adjusted for age, race, income, education, physical activity, alcohol consumption, smoking, fruit and vegetable consumption

# Body Mass Index (BMI) >=25 kg/m2 and =< 29.9 kg/m2

† Body Mass Index > = 30 kg/m2

# †

Reference: Normal Weight

BODY WEIGHT STATUS

0.74

0.95

1.5

0.61

1.050.76

0

1

2

Physically Active Some Activity ##

†

Odds Ratio

*Adjusted for age, race, income, education, obesity, alcohol consumption, smoking, fruit and vegetable consumption

# > 20 minutes of vigorous activity >= 3 day/wk; or >= 30 minutes of moderate activity >=5 days/wk

† Some physical activity but not at the recommended level

Reference: Sedentary

1.140.95

1.29

0.690.45

2.25

0.94

1.6

0.66

0

1

2

3

African-Americans

Asians/ PacificIslanders

Latinos

Odds Ratio

*Adjusted for age, income, education, physical activity, obesity, alcohol consumption, smoking, fruit and vegetable consumption

Reference: Whites

0.5

1.04

0.57

0.61

1.21.22

0.720.87 0.83

0

1

2

100-199% FPL 200-299% FPL >=300% FPL

Odds Ratio

*Adjusted for age, race, education, physical activity, obesity, smoking, alcohol consumption, fruit and vegetable consumption

$ Based on 2002 Federal Poverty Level (FPL) thresholds which for a family of four (2 adults, 2 dependents) correspond to annual incomes of $18,859 (100% FPL), $37,718 (200% FPL), and $56,557 (300% FPL).

Reference: 0-99% FPL

RACE EDUCATION

HOUSEHOLD FEDERAL POVERTY LEVEL$

PHYSICAL ACTIVITY