Shakia Hardy

BACKGROUND The prevalence of many chronic conditions has increased among US adults. Many adults with hypertension have other chronic conditions. METHODS We estimated changes in the age-adjusted prevalence of multiple (≥3) chronic conditions, not including hypertension, using data from the National Health and Nutrition Examination Survey, from 1999–2000 to 2017–2020, among US adults with (n = 24,851) and without (n = 24,337 hypertension. Hypertension included systolic blood pressure (BP) ≥130 mm Hg, diastolic BP ≥80 mm Hg, or antihypertensive medication use. We studied 14 chronic conditions: arthritis, asthma, cancer, coronary heart disease, chronic kidney disease, depression, diabetes, dyslipidemia, hepatitis B, hepatitis C, heart failure, lung disease, obesity, and stroke. RESULTS From 1999–2000 to 2017–2020, the age-adjusted mean number of chronic conditions increased more among US adults with vs. without hypertension (2.2 to 2.8 vs. 1.7 to 2.0; P-interaction <0.001). Also, the age-adjusted prevalence of multiple chronic conditions increased from 39.0% to 52.0% among US adults with hypertension and from 26.0% to 30.0% among US adults without hypertension (P-interaction = 0.022). In 2017–2020, after age, gender, and race/ethnicity adjustment, US adults with hypertension were 1.94 (95% confidence interval: 1.72–2.18) times as likely to have multiple chronic conditions compared to those without hypertension. In 2017–2020, dyslipidemia, obesity, and arthritis were the most common 3 co-occurring chronic conditions among US adults with and without hypertension (age-adjusted prevalence 16.5% and 3.1%, respectively). CONCLUSIONS In 2017–2020, more than half of US adults with hypertension had ≥3 additional chronic conditions, a substantial increase from 20 years ago.

Background High rates of hypertension and poverty in the rural south contribute to health disparities with Black adults experiencing higher rates of cardiovascular disease than White adults, underscoring the need to identify prevention strategies. Methods The equity in prevention and progression of hypertension by addressing barriers to nutrition and physical activity (EPIPHANY) study is a cluster randomized controlled trial testing a multilevel intervention to reduce barriers to a healthy lifestyle to lower blood pressure (BP) among rural, Black adults. Health education fairs offered to 20 churches in the Alabama Black Belt are being used to screen and enroll adults with elevated BP or stage 1 hypertension (systolic BP 120–139 mmHg and diastolic BP < 90 mmHg) who are not recommended for antihypertensive medication, according to the 2017 American College of Cardiology/American Heart Association BP guideline. Participants (n = 240) in churches randomized to the control condition are offered access to online resources including cooking and exercise classes. Participants (n = 240) in churches randomized to the intervention are receiving access to online resources; telephone-based peer support for lifestyle modification; funding for churches to develop programs to address food access and/or barriers to physical activity; and training of church members to serve as church champions to deliver training for church members on lifestyle modification. We will employ a Type 1 hybrid implementation-effectiveness design to assess effectiveness and implementation. Conclusions The EPIPHANY study is designed to prevent hypertension among rural, Black adults by addressing structural and individual barriers to lifestyle modification through peer support.