Southerners at Increased Risk for High Blood Pressure

Southerners at Increased Risk for High Blood Pressure High blood pressure, a major risk factor for stroke, is more prevalent among Southerners than their non-Southern counterparts of the same age and gender news cardiology,neurology/neurosurgery, primary care MedscapeWire is edited by Deborah Flapan, an associate editor at Medscape. Send press releases and comments to medscapewire2@medscapeinc.com. Medscape Portals, Inc MedscapeWire 01/06/2000 <H4>Introduction</H4> New York (MedscapeWire) Jan 6 High blood pressure, a major risk factor for stroke, is more prevalent among Southerners than their non-Southern counterparts of the same age and gender, according to a new study in the January issue of <cite>Stroke.</cite> Researchers examined data on 6278 Caucasians and African Americans whotook part in the Third National Health and Nutritional Examination Survey(NHANES III) from 1988 to 1994. The new study found that even aftercontrolling for factors such as age and sex, Southerners were more likelyto have high blood pressure readings than non-Southerners. A reading of140/90 millimeters of mercury (mm Hg) or higher was considered high bloodpressure. Prevalence of high blood pressure was higher among 60- to 79-year-oldSouthern residents compared with non-Southern residents of the United States(59% vs 54%). A higher percentage of older Southern white men(60-79 years) had high blood pressure compared with similar ethnic-gender groups in the non-Southern region. States included in the authors' definition of the "South" were: Alabama,Arkansas, Delaware, Florida, Georgia, Kentucky, Louisiana, Maryland,Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas,Virginia, and West Virginia. Washington, DC, was also included. Many of thesesame states make up the "stroke belt" a region of the United States thathas a greater proportion of strokes. "Lack of access to healthcare, lower socioeconomic status, environmentalfactors and even dietary differences such as higher-sodium and lower-potassiumdiets may contribute to the geographic variation," says the study's leadauthor Thomas O. Obisesan, MD, MPH, assistant professor of medicine atHoward University Hospital in Washington, DC. "There are a number ofpossibilities." Compared with their non-Southern counterparts, older African-American menin the South demonstrated higher awareness (78.3% vs 67.3%) andtreatment of high blood pressure (65.7% vs 53.1%) but had alower rate of blood pressure control with medication (34.5% vs 45.4%). "We found that even though awareness of high blood pressure had increased,we're still not controlling it as well as we should," says Obisesan."Patients have not been compliant in taking their medication and perhapsphysicians have not been aggressive enough in treating high blood pressure." Further examining the data, researchers also found differences in highblood pressure rates along urban/rural lines. By studying data on African-American men, the researchers found that 70.4% of African-American menliving in nonmetropolitan areas in the South had high blood pressure, compared with54.3% of African-American men living in Southern metropolitan areas. "Several interventions targeting lifestyle risk factors for high bloodpressure currently exist," says Obisesan. "However, for these interventionsto have optimal benefit, it is important to target high-risk populations." High blood pressure is one of several risk factors for stroke that can beimproved through treatment or behavior change. Others include smoking,obesity, physical inactivity, and diabetes. Risk factors that cannot bechanged include race, sex, and age. "Once physicians recognize the patient has high blood pressure, thereneeds to be follow-up with aggressive treatment and a strong patient effort tofollow doctor's orders," says Obisesan. "What we're seeing is much different a lack of aggressiveness and a lack of compliance leading to more instancesof uncontrolled high blood pressure, which can lead to more strokes."