The association of hypertension, hypertension duration, and control with incident heart failure in black and white adults

Abstract Associations between hypertension and some cardiovascular diseases are stronger in black vs white adults. We examined associations of hypertension, hypertension duration, and control with incident heart failure (HF) in black and white REasons for Geographic And Racial Differences in Stroke study participants (n = 25 770) who were followed for incident HF hospitalization (n = 947) from enrollment in 2003‐2007 through 2015. Hypertension was defined, using updated US guidelines, as systolic or diastolic blood pressure (BP) ≥130/80 mm Hg or antihypertensive medication use. Duration was assessed at baseline, and control was defined as treated BP < 130/80 mm Hg. Compared with no hypertension, hypertension was associated with higher risk of incident HF (HR whites 1.90 95% CI 1.49, 2.41, HR blacks 2.36 95% CI 1.53, 3.65), HF with preserved ejection fraction (HR whites 2.01 95% CI 1.34, 3.01, HR blacks 2.70 95% CI 1.25, 2.53), and HF with reduced/mid‐range ejection fraction (HR whites 1.69 95% CI 1.23, 2.33, HR blacks 2.29 95% CI 1.26, 4.15). Hypertension duration <10 years and ≥10 years were associated with higher risk for incident HF compared with no hypertension. Although risk of incident HF was highest among participants with uncontrolled BP, even controlled BP vs no hypertension was associated with increased risk of HF (HR whites 1.93 95% CI 1.44, 2.58, HR blacks 2.01 95% CI 1.22, 3.29). Interactions with race were not statistically significant. The risk of HF associated with hypertension, even with shorter duration or controlled BP, suggests that both prevention and therapeutic management of hypertension are important in reducing HF risk.