title: Racial Disparity in Cognitive and Functional Disability in Hypertension and All-Cause Mortality.
abstract: BACKGROUND
  Subjective cognitive and functional limitations are early markers of future dementia and physical disability. Hypertension may increase the risk of dementia; however, the magnitude and significance of subjective limitations in the hypertensive US population are unknown, particularly in African Americans who bear the greatest burden of hypertension. Our objectives were to assess the prevalence and racial disparity of subjective cognitive and functional limitations and their impact on mortality in the hypertensive US population.
  
  
  METHODS
  We analyzed data from the National Health and Nutrition Examination Survey (NHANES) collected between 1999 and 2010 (N = 28,477; 31% with hypertension; 11% African American), which included blood pressure measurement, self-reported cognitive and functional (physical and non-physical) limitations, and all-cause mortality. Complex survey regression models were used.
  
  
  RESULTS
  In the United States, 8% of the hypertensive population reported cognitive and 25% reported functional limitations (vs. 5.7% and 15% respectively in the non-hypertensive population, P < 0.0001). Hypertensive African Americans carried the highest burden of cognitive (11%, P = 0.01) and functional (27%, P = 0.03) limitations compared to non-hypertensive African Americans and to non-African Americans. All-cause mortality was significantly higher in hypertensive individuals who reported cognitive or functional limitations (P < 0.0001 for both) relative to those without either.
  
  
  CONCLUSIONS
  The prevalence of cognitive and functional disability is larger in the US hypertensive population compared to the non-hypertensive population. African Americans with hypertension carry a disproportionate burden of these limitations. Individuals with hypertension who report cognitive or functional symptoms have higher all-cause mortality and query about these symptoms should be part of hypertension evaluation.
authors.affiliation: Division of Geriatrics and General Internal Medicine, Department of Medicine and Neurology, Emory University, Atlanta, Georgia, USA; Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA; Emory Alzheimer's Disease Research Center, Emory University School of Medicine, Atlanta, Georgia, USA; ihajjar@emory.edu.
authors.forename: Ihab
authors.initials: I
authors.lastname: Hajjar
authors.affiliation: Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA; Emory Alzheimer's Disease Research Center, Emory University School of Medicine, Atlanta, Georgia, USA;
authors.forename: Whitney
authors.initials: W
authors.lastname: Wharton
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
authors.forename: Wendy J
authors.initials: WJ
authors.lastname: Mack
authors.affiliation: Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA; Emory Alzheimer's Disease Research Center, Emory University School of Medicine, Atlanta, Georgia, USA;
authors.forename: Allan I
authors.initials: AI
authors.lastname: Levey
authors.affiliation: Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA; Emory Alzheimer's Disease Research Center, Emory University School of Medicine, Atlanta, Georgia, USA;
authors.forename: Felicia C
authors.initials: FC
authors.lastname: Goldstein
mesh_terms: D000328:Adult; D000367:Age Factors; D001794:Blood Pressure; D003072:Cognition Disorders / Q000208:ethnology* / Q000209:etiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000208:ethnology* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000208:ethnology*; D009749:Nutrition Surveys; D015995:Prevalence; D012737:Sex Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: African American; blood pressure; cognition; disparity; hypertension.