African American women and men at high and low risk for hypertension: A signal detection analysis of NHANES III, 1988-19941

Background. African Americans have some of the highest rates of hypertension in the world. This study identified subgroups of U.S. African American women and men with particularly high and low rates of hypertension. Methods. Data are presented for 1,911 Black women and 1,657 Black men, ages 25-84 from the Third National Health and Nutrition Examination Survey, 1988-1994. Signal detection methodology identified high and low risk subgroups; stratified analyses characterized the population of hypertensives. Results. We identified 12 distinct subgroups with highly variable rates of hypertension (11-78%). The two groups with the highest rates of hypertension (>70% hypertensive) were more likely to be middle aged or older, less educated, overweight or obese (>80%), physically inactive (50%), and to have diabetes (28 and 100% diabetic). The two groups with the lowest hypertension rates (<18% hypertensive) were more likely to be younger, but were also overweight or obese (>50%). Among hypertensives, those who were uncontrolled and not on antihypertensive medications were distinguished by their male gender, younger age, and infrequent contact with a physician. Conclusions. Hypertension rates vary substantially within African Americans, illustrating the need for effective weight management, diabetes control, and increased access to health care for those at highest risk. (C) 2002 American Health Foundation and Elsevier Science (USA).