Education differences in blood pressure trajectories by sex through midlife: Findings from the National Health and Nutrition Examination Survey, 1999-2018

Abstract

Objective: Although it has long been established that age and sex play a role in blood pressure levels across the lifespan, the extent to which educational attainment moderates these relationships has been understudied. Thus, the purpose of this study was to assess educational differences in SBP, DBP, and pulse pressure (PP) trajectories among men and women through the midlife years.

Method: We conducted an analysis of pooled data from the 1999 to 2018 National Health and Nutrition Examination Survey to assess whether education moderates blood pressure measurements among men and women over the midlife years. Statistical analyses were performed using survey-weighted linear and quadratic regressions to assess these trajectories.

Results: During midlife, women with at least a college degree maintained the lowest average level of SBP compared to men at all education levels and women with a high school diploma or less. They also maintained the lowest level of PP, though not different from men with at least a college degree and women with less than a college degree. However, no educational differences were observed in DBP between men and women during the midlife years.

Conclusion: Our study shows clear delineation in the trajectories of PP and SBP by education such that a 4-year education is more protective than some college and a high school degree, particularly among women. These results highlight the need to consider upstream policy interventions (education policy initiatives) that could reduce population-wide elevated blood pressure.

Fig. 1

Sex-stratified predicted mean SBP measurements with age among Americans during the Midlife by Educational Attainment (n = 35 708). Linear relationships between age and SBP, stratified by sex (male vs. female) and educational attainment (<high school, high school, some college, and ≥ college degree).

Fig. 2

Sex-stratified predicted mean DBP measurements with age among US adults during the midlife by educational attainment (n = 35 708). Curvilinear relationships between age and DBP, stratified by sex (male vs. female) and educational attainment (<high school, high school, some college, and ≥college degree).

Fig. 3

Sex-stratified predicted mean pulse pressure measurements with age among. Americans during the midlife by educational attainment (n = 35 708). Linear relationships between age and pulse pressure, stratified by sex (male vs. female) and educational attainment (<high school, high school, some college, and ≥college degree).