title: Prevalence of hypertension by duration and age at exposure to the stroke belt.
abstract: Geographic variation in hypertension is hypothesized as contributing to the stroke belt, an area in the southeastern United States with high stroke mortality. No study has examined hypertension by lifetime exposure to the stroke belt. This association was studied in 19,385 participants in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study, a national population-based cohort. Prevalent hypertension was defined as systolic blood pressure >/=140, diastolic blood pressure >/=90, or use of antihypertensive medications. Stroke belt exposure was assessed by residence at birth, currently, early childhood, adolescence, early adulthood, mid-adulthood, and recently. After adjustment for age, race, sex, physical activity level, body mass index, smoking, alcohol, education, and income, the prevalence of hypertension was significantly more strongly related (P < .0001) with lifetime exposure, adolescence, or early adulthood exposure than exposures at other times. Birthplace and current residence were independently associated with hypertension; however, lifetime, adolescence, or early adulthood exposures were more predictive than joint model with both birthplace and current residence. That adolescence and early adulthood periods are more predictive than residence in the stroke belt for most recent 20-year period suggests community and environmental strategies to prevent hypertension need to start earlier in life.
authors.affiliation: Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35294-0022, USA. vjhoward@uab.edu
authors.forename: Virginia J
authors.initials: VJ
authors.lastname: Howard
authors.forename: Robert F
authors.initials: RF
authors.lastname: Woolson
authors.forename: Brent M
authors.initials: BM
authors.lastname: Egan
authors.forename: Joyce S
authors.initials: JS
authors.lastname: Nicholas
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Adams
authors.forename: George
authors.initials: G
authors.lastname: Howard
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Lackland
mesh_terms: D000368:Aged; D044383:Black People; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D015995:Prevalence; D012111:Residence Characteristics; D015144:Southeastern United States / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology*; D044465:White People; D001741:Black or African American