Association of region of residence and immigrant status with hypertension, renal failure, cardiovascular disease, and stroke, among African-American participants in the third National Health and Nutrition Examination Survey (NHANES III)

Abstract

Objective: To determine whether current region of residence and immigrant status (born in the United States [US] vs abroad), are associated with the prevalence of hypertension (HTN), uncontrolled HTN, and HTN-related target-organ damage, among African Americans.

Methods: We studied the survey and physical examination data from a nationally representative cohort of 3,369 self-designated Black participants, aged 30-79 years, in the third National Health and Nutrition Examination Survey (NHANES III), which took place during 1988-1994. We calculated the age-adjusted prevalence rates of HTN, uncontrolled HTN, and history of HTN-related target-organ damage in US-born northern African Americans, US-born southern African Americans, and foreign-born African Americans.

Results: Hypertension (HTN) was more common among southern African-American men and women, compared to northern African-American men and women (42.2% vs 34.1%, P<.002 for men; 42.7% vs 37.2%, P=.02 for women). Uncontrolled HTN was also more common among hypertensive southern African-American women compared to hypertensive northern African-American women (79.8% vs 70.4%, P=.05). Among women, hypertensive Black immigrants had lower rates of HTN-related target-organ damage than either hypertensive US-born southern and northern African Americans (3.3% vs 16.3% and 15.8%, respectively, P=.05).

Conclusions: In this nationally representative cohort, immigrant status and geographic region of residence were associated with HTN prevalence, rates of blood pressure control, and HTN-related target-organ damage. Further examination of environmental exposures, cultural issues, and access to care, factors that can differ between groups, may yield important information about modifiable risk factors associated with HTN and target organ damage.