title: Association between self-rated health and incident severe hypertension among men: a population-based cohort study.
abstract: BACKGROUND
  Self-rated health (SRH) is a consistent predictor of cardiovascular disease and mortality. However, the intermediate biological mechanisms behind this association are not clear. We examined the longitudinal relationship between SRH and incident severe hypertension.
  
  
  METHODS
  We studied a population-based cohort of 1,298 participants (mean age 62.5 years, range 49-84 years), at the baseline examination (1992-1994) residing in the Blue Mountains region, west of Sydney, Australia, and re-examined after five years (1997-1999). Main outcome-of-interest was incident severe hypertension (systolic blood pressure [BP] 160 mmHg or above, diastolic BP 100 mmHg or above, or a combination of self-reported hypertension diagnosis and use of antihypertensive medications) among baseline individuals without severe hypertension.
  
  
  RESULTS
  Among men, those with fair/poor SRH had significantly higher odds of incident severe hypertension, compared to individuals with excellent SRH. Multivariable odds-ratio (OR) (95 percent confidence intervals [CI]) comparing fair/poor SRH to excellent SRH was 1.93 (1.04-3.56) (p-trend was 0.03). This association was not observed in women comparing fair/poor SRH to excellent SRH: OR 0.96, 95 percent CI 0.57-1.62 (p-trend was 0.70). Subgroup analyses stratified by age, smoking, body mass index, diabetes mellitus and BP categories, supported this male gender-specific pattern of association.
  
  
  CONCLUSIONS
  This data suggests an association between poor SRH and incident hypertension among men, but not among women. These results suggest that at least part of the previously-reported association between poor SRH and mortality may be mediated by its relation to incident severe hypertension.
authors.affiliation: Department of Community, Occupational, and Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. ashankar@hsc.wvu.edu
authors.forename: A
authors.initials: A
authors.lastname: Shankar
authors.forename: J J
authors.initials: JJ
authors.lastname: Wang
authors.forename: E
authors.initials: E
authors.lastname: Rochtchina
authors.forename: P
authors.initials: P
authors.lastname: Mitchell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000175:diagnosis; D015331:Cohort Studies; D005260:Female; D006304:Health Status; D006305:Health Status Indicators; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D013997:Time Factors