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Antihypertensive drug use and blood pressure control among stroke survivors in the United States: NHANES 2003-2014.

ABSTRACT: Understanding the patterns of antihypertensive drug use and blood pressure (BP) control among stroke survivors in the "real-world" setting is important to identify gaps in treatment and control, if any. The objective of our study was to assess trends and patterns in antihypertensive drug use and BP control among stroke survivors in the United States. We performed a retrospective cross-sectional analysis of the 2003-2014 National Health and Nutrition Examination Survey (NHANES). Stroke and hypertension diagnoses were self-reported. Information regarding the use of antihypertensive drugs was collected during an in-person interview. Measurement of BP was performed by trained medical professionals in mobile examination centers. A total 1244 adult stroke survivors (equating to 6 232 215 stroke survivors nationwide) were identified, of which 956 had hypertension. Antihypertensive drug use increased from 2003 (79.5%) to 2014 (92.2%; P for trend < 0.001). The prevalence of drug use was lower (52%) among survivors aged 20-39 years compared with older age groups. Use of ≥2 antihypertensive drugs was prevalent (63.8%), but diuretics alone or in combination with angiotensin-converting enzyme inhibitors were underutilized (22.4%). More than one-third of the survivors were not at BP goal (ie, BP < 140/90 mm Hg). Males were more likely to attain BP goal than female stroke survivors (odds ratio [OR] = 2.02; 95% CI: 1.34-3.05). Our findings suggest that despite improvements in antihypertensive drug use in the recent years, BP is not adequately controlled in a significant proportion of stroke survivors. Further research focusing on understanding the reasons for unmet BP goal in stroke survivors is needed.

SUBMITTER: Sonawane K

PROVIDER: S-EPMC8030507 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundPolycyclic aromatic hydrocarbons (PAHs) are environmental contaminants that are hepatotoxic and immunotoxic. PAH exposure may modulate hepatitis B immunology.ObjectiveWe used data from 6 cycles of the National Health and Nutrition Examination Survey (2003-2014) to evaluate the associations between urinary PAH metabolites and hepatitis B serology.MethodsThis analysis included individuals who self-reported receiving ≥3 doses of hepatitis B vaccine and urinary PAH metabolites (i.e. 1-napthol, 2-napthol, 3-fluorene, 2-fluorene, 1-phenanthrene, 1-pyrene, and total PAH [sum of all metabolites]). Separate logistic regression models assessed the association between hepatitis B vaccination status (i.e. individuals who were immune due to vaccination or susceptible) and tertiles of urinary PAH. Models were adjusted for age, gender, race/ethnicity, survey cycle, family income to poverty ratio, BMI, country of birth, serum cotinine, and urinary creatinine.ResultsAmong participants who reported receiving ≥3 doses of vaccine and had no antibodies indicating a history of hepatitis B infection and/or current hepatitis B infection, dose-response relationships were observed where individuals with the lowest odds of serology indicating a response to the hepatitis B vaccine (i.e., anti-HBs+, anti-HBc-, and HBsAg-) were in the highest tertile of 2-Napthol (adjusted Odds Ratio [aOR]: 0.70, 95% confidence interval [CI]: 0.54, 0.91), 3-Napthol (aOR: 0.68, 95% CI: 0.53, 0.87), 2-Fluorene (aOR: 0.61, 95% CI: 0.54, 0.86), 1-Phenanthrene (aOR: 0.79, 95% CI: 0.65, 0.97), 1-Pyrene (aOR): 0.68, 95% CI: 0.55, 0.83), and total PAH (aOR: 0.73, 95% CI: 0.56, 0.95) had the compared to the lowest tertile.ConclusionThis cross-sectional study supports a hypothesis that PAH exposures experienced by the general US population may modulate hepatitis B vaccine induced immunity. Given the ubiquity of PAH exposures in the US, additional research is warranted to explore the effects of chronic PAH exposures on hepatitis B related humoral immunity.

Project description:BackgroundOrganophosphate (OP) insecticides represent one of the largest classes of sprayed insecticides in the U.S., and their use has been associated with various adverse health outcomes, including disorders of blood pressure regulation such as hypertension (HTN).MethodsIn a study of 935 adults from the NHANES 2013-2014 cycle, we examined the relationship between systolic and diastolic blood pressure changes and urinary concentrations of three OP insecticides metabolites, including 3,5,6-trichloro-2-pyridinol (TCPy), oxypyrimidine, and para-nitrophenol. These metabolites correspond to the parent compounds chlorpyrifos, diazinon, and methyl parathion, respectively. Weighted, multivariable linear regression analysis while adjusting for potential confounders were used to model the relationship between OP metabolites and blood pressure. Weighted, multivariable logistic regression analysis was used to model the odds of HTN for quartile of metabolites.ResultsWe observed significant, inverse association between TCPy on systolic blood pressure (β-estimate = -0.16, p < 0.001) and diastolic blood pressure (β-estimate = -0.15, p < 0.001). Analysis with para-nitrophenol revealed a significant, positive association with systolic blood pressure (β-estimate = 0.03, p = 0.02), and an inverse association with diastolic blood pressure (β-estimate = -0.09, p < 0.001). For oxypyrimidine, we observed significant, positive associations between systolic blood pressure (β-estimate = 0.58, p = 0.03) and diastolic blood pressure (β-estimate = 0.31, p < 0.001). Furthermore, we observed significant interactions between TCPy and ethnicity on systolic blood pressure (β-estimate = 1.46, p = 0.0036). Significant interaction terms were observed between oxypyrimidine and ethnicity (β-estimate = -1.73, p < 0.001), as well as oxypyrimidine and BMI (β-estimate = 1.51 p < 0.001) on systolic blood pressure, and between oxypyrimidine and age (β-estimate = 1.96, p = 0.02), race (β-estimate = -3.81 p = 0.004), and BMI on diastolic blood pressure (β-estimate = 0.72, p = 0.02). A significant interaction was observed between para-nitrophenol and BMI for systolic blood pressure (β-estimate = 0.43, p = 0.01), and between para-nitrophenol and ethnicity on diastolic blood pressure (β-estimate = 2.19, p = 0.006). Lastly, we observed a significant association between the odds of HTN and TCPy quartiles (OR = 0.65, 95% CI [0.43,0.99]).ConclusionOur findings support previous studies suggesting a role for organophosphate insecticides in the etiology of blood pressure dysregulation and HTN. Future studies are warranted to corroborate these findings, evaluate dose-response relationships between organophosphate insecticides and blood pressure, determine clinical significance, and elucidate biological mechanisms underlying this association.

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Antihypertensive drug use and blood pressure control among stroke survivors in the United States: NHANES 2003-2014.

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