@article {13576, title = {Neighborhood Characteristics and Elevated Blood Pressure in Older Adults.}, journal = {JAMA Network Open}, year = {2023}, month = {2023 Sep 05}, pages = {e2335534}, abstract = {

IMPORTANCE: The local environment remains an understudied contributor to elevated blood pressure among older adults. Untargeted approaches can identify neighborhood conditions interrelated with racial segregation that drive hypertension disparities.

OBJECTIVE: To evaluate independent associations of sociodemographic, economic, and housing neighborhood factors with elevated blood pressure.

DESIGN, SETTING, AND PARTICIPANTS: In this cohort study, the sample included Health and Retirement Study participants who had between 1 and 3 sets of biennial sphygmomanometer readings from 2006 to 2014 or 2008 to 2016. Statistical analyses were conducted from February 5 to November 30, 2021.

EXPOSURES: Fifty-one standardized American Community Survey census tract variables (2005-2009).

MAIN OUTCOMES AND MEASURES: Elevated sphygmomanometer readings over the study period (6-year period prevalence): a value of at least 140 mm Hg for systolic blood pressure and/or at least 90 mm Hg for diastolic blood pressure. Participants were divided 50:50 into training and test data sets. Generalized estimating equations were used to summarize multivariable associations between each neighborhood variable and the period prevalence of elevated blood pressure, adjusting for individual-level covariates. Any neighborhood factor associated (Simes-adjusted for multiple comparisons P <= .05) with elevated blood pressure in the training data set was rerun in the test data set to gauge model performance. Lastly, in the full cohort, race- and ethnicity-stratified associations were evaluated for each identified neighborhood factor on the likelihood of elevated blood pressure.

RESULTS: Of 12 946 participants, 4565 (35\%) had elevated sphygmomanometer readings (median [IQR] age, 68 [63-73] years; 2283 [50\%] male; 228 [5\%] Hispanic or Latino, 502 [11\%] non-Hispanic Black, and 3761 [82\%] non-Hispanic White). Between 2006 and 2016, a lower likelihood of elevated blood pressure was observed (relative risk for highest vs lowest tertile, 0.91; 95\% CI, 0.86-0.96) among participants residing in a neighborhood with recent (post-1999) in-migration of homeowners. This association was precise among participants with non-Hispanic White and other race and ethnicity (relative risk, 0.91; 95\% CI, 0.85-0.97) but not non-Hispanic Black participants (relative risk, 0.97; 95\% CI, 0.85-1.11; P = .48 for interaction) or Hispanic or Latino participants (relative risk, 0.84; 95\% CI, 0.65-1.09; P = .78 for interaction).

CONCLUSIONS AND RELEVANCE: In this cohort study of older adults, recent relocation of homeowners to a neighborhood was robustly associated with reduced likelihood of elevated blood pressure among White participants but not their racially and ethnically marginalized counterparts. Our findings indicate that gentrification may influence later-life blood pressure control.

}, keywords = {Aged, Blood pressure, Cohort Studies, ethnicity, Female, Humans, Hypertension, Male, Neighborhood characteristics}, issn = {2574-3805}, doi = {10.1001/jamanetworkopen.2023.35534}, author = {Sims, Kendra D and Willis, Mary D and Hystad, Perry W and Batty, G David and Bibbins-Domingo, Kirsten and Smit, Ellen and Odden, Michelle C} } @article {12489, title = {Discrimination, Mediating Psychosocial or Economic Factors, and Antihypertensive Treatment: A 4-Way Decomposition Analysis in the Health and Retirement Study.}, journal = {American Journal of Epidemiology}, volume = {191}, year = {2022}, pages = {1710-1721}, abstract = {

Untested psychosocial or economic factors mediate associations between perceived discrimination and suboptimal antihypertensive therapy. This study included two waves of data from the Health and Retirement Study participants with self-reported hypertension (N=8557, 73\% Non-Hispanic White, 17\% Non-Hispanic Black, and 10\% Hispanic/Latino) over four years (2008-2014). Our primary exposures were frequency of experiencing discrimination in everyday life or across seven lifetime circumstances. Candidate mediators were self-reported depressive symptoms, subjective social standing, and household wealth. We evaluated with causal mediation methods the interactive and mediating associations between each discrimination measure and reported antihypertensive use at the subsequent wave. In unmediated analyses, everyday (OR; 95\% CI: 0.86; 0.78, 0.95) as well as lifetime discrimination (OR; 95\% CI: 0.91; 0.85, 0.98) were associated with a lower likelihood of antihypertensive use. Discrimination was associated with lower wealth, greater depressive symptoms, and decreased subjective social standing. Estimates for associations due to neither interaction nor mediation resembled unmediated associations for most discrimination-mediator combinations. Lifetime discrimination was indirectly associated with reduced antihypertensive use via depressive symptomology (OR; 95\% CI: 0.99; 0.98, 1.00). In conclusion, the impact of lifetime discrimination on the underuse of antihypertensive therapy appears partially mediated by depressive symptoms.

}, keywords = {antihypertensive, causal mediation, Perceived Discrimination, Psychosocial, Wealth}, issn = {1476-6256}, doi = {10.1093/aje/kwac102}, author = {Sims, Kendra D and Batty, G David and Smit, Ellen and Hystad, Perry W and McGregor, Jessina C and Odden, Michelle C} } @article {12248, title = {Intersectional Discrimination and Change in Blood Pressure Control Among Older Adults: The Health and Retirement Study.}, journal = {The Journals of Gerontology: Series A }, volume = {77}, year = {2022}, pages = {375-382}, abstract = {

BACKGROUND: Associations between multiple forms of discrimination and blood pressure control in older populations remain unestablished.

METHODS: Participants were 14 582 noninstitutionalized individuals (59\% women) in the Health and Retirement Study aged at least 51 years (76\% non-Hispanic White, 15\% non-Hispanic Black, 9\% Hispanic/Latino). Primary exposures included the mean frequency of discrimination in everyday life, intersectional discrimination (defined as marginalization ascribed to more than one reason), and the sum of discrimination over the life span. We assessed whether discrimination was associated with a change in measured hypertension status (N = 14 582) and concurrent medication use among reported hypertensives (N = 9 086) over 4 years (2008-2014).

RESULTS: There was no association between the frequency of everyday discrimination and change in measured hypertension. Lifetime discrimination was associated with higher odds of hypertension 4 years later among men (odds ratio [OR]: 1.21, 95\% confidence interval [CI]: 1.08-1.36) but not women (OR: 0.98, 95\% CI: 0.86-1.13). Only among men, everyday discrimination due to at least 2 reasons was associated with a 1.44-fold (95\% CI: 1.03-2.01) odds of hypertension than reporting no everyday discrimination, reporting intersectional discrimination was not associated with developing hypertension among women (OR: 0.91, 95\% CI: 0.70-1.20). All 3 discriminatory measures were inversely related to time-averaged antihypertensive medication use, without apparent gender differences (eg, OR for everyday discrimination-antihypertensive use associations: 0.85, 95\% CI: 0.77-0.94).

CONCLUSIONS: Gender differences in marginalization may more acutely elevate hypertensive risk among older men than similarly aged women. Experiences of discrimination appear to decrease the likelihood of antihypertensive medication use among older adults overall.

}, keywords = {cardiovascular, Health Disparities, Risk Factors, Socioeconomic issues}, issn = {1758-535X}, doi = {10.1093/gerona/glab234}, author = {Kendra D Sims and Smit, Ellen and G David Batty and Hystad, Perry W and Michelle C Odden} } @article {8979, title = {Functional Status Modifies the Association of Blood Pressure with Death in Elders: Health and Retirement Study}, journal = {Journal of the American Geriatrics Society}, volume = {65}, year = {2017}, pages = {1482-1489}, abstract = {Objective To examine whether grip strength, gait speed, and the combination of the two physical functioning measures modified the association of systolic BP (SBP) and diastolic BP (DBP) with mortality. Design Nationally representative cohort study. Setting Health and Retirement Study. Participants 7,492 U.S. adults aged >=65 years. Measurements Grip strength was measured by a hand dynamometer and classified as normal (>=16 kg for female; >=26 kg for male) and weak. Gait speed was assessed over a 98.5-inch walk and classified as non-slow (>=0.60 m/s for female; >=0.52 m/s for male) and slow. Results Over an average follow-up time of 6.0 years, 1,870 (25.0\%) participants died. After adjustment for socio-demographic, behavioral, and clinical measures, elevated SBP (>=150 mmHg) and DBP (>=90 mmHg) was associated with a 24\% (95\% CI, 7{\textendash}43\%) and 25\% (95\% CI, 5{\textendash}49\%) higher mortality among participants with normal grip strength. In contrast, elevated SBP and DBP was associated with a 6\% (95\% CI, 31 to -27\%) and a 16\% (95\% CI, 46 to -26\%) lower mortality among those with weak grip strength (P-values of interactions: both=.07). The inverse relations between BP with death were most pronounced among slow walkers with weak grip strength. The HRs of elevated SBP and DBP for death was 0.85 (95\% CI, 0.56{\textendash}1.29) and 0.53 (95\% CI, 0.30{\textendash}0.96), respectively, and was substantially different from non-slow walkers with normal grip strength (HR = 1.24 and 1.15, respectively; P-values of interactions: both <.001). Therefore, associations of BP with death varied modestly by gait speed. Conclusion Grip strength modified the association of BP with death. Combination of grip strength and gait speed has incremental value for modifying the association of BP with death.}, keywords = {Blood pressure, Grip strength, Mortality, Older Adults}, doi = {10.1111/jgs.14816}, url = {http://doi.wiley.com/10.1111/jgs.14816http://onlinelibrary.wiley.com/wol1/doi/10.1111/jgs.14816/fullpdfhttps://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1111\%2Fjgs.14816}, author = {Wu, Chenkai and Smit, Ellen and Peralta, Carmen A and Sarathy, Harini and Michelle C Odden} }