Incidence, cardiovascular complications and mortality of hypertension by sex and ethnicity
- Hude Quan1,
- Guanmin Chen1,
- Robin L Walker1,
- Andy Wielgosz2,
- Sulan Dai3,
- Karen Tu4,5,
- Norm R C Campbell1,6,
- Brenda R Hemmelgarn1,6,
- Michael D Hill1,6,7,
- Helen Johansen2,
- Finlay A McAlister8,
- Nadia Khan9,
- for Hypertension Outcome and Surveillance Team
- 1Department of Community Health Sciences, University of Calgary, Calgary, Canada
- 2Department of Medicine, University of Ottawa, Ottawa, Canada
- 3Public Health Agency of Canada, Ottawa, Canada
- 4Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- 5Institute for Clinical Evaluative Sciences (ICES), Toronto, Canada
- 6Department of Medicine, University of Calgary, Calgary, Canada
- 7Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
- 8Division of General Internal Medicine, University of Alberta, Edmonton, Canada
- 9Division of General Internal Medicine, University of British Columbia, Vancouver, Canada
- Correspondence to Dr Hude Quan, Department of Community Health Sciences, University of Calgary, 3280 Hospital Dr NW, Calgary, Alberta, Canada T2N 4Z6;
- Received 3 October 2012
- Revised 22 December 2012
- Accepted 27 December 2012
- Published Online First 12 February 2013
Objective To compare ethnic and sex difference in the incidence of newly diagnosed hypertension, and subsequent risk of cardiovascular disease outcomes among South Asian, Chinese and white patients.
Methods We identified patients with newly diagnosed hypertension aged ≥20 years. Patients were followed for 1–9 years for all-cause mortality and cardiovascular disease with myocardial infarction, heart failure and stroke. Cox proportional hazard models stratified by sex and adjusted for age, median income and co-morbid conditions, were constructed to determine the independent association between ethnicity and the development of the combined cardiovascular endpoint as well as death.
Results There were 39 175 South Asian (49.4% men, 34.4% age ≥65), 49 892 Chinese (48.1% men, 36.7% age ≥65) and 841 277 white (47.9% men, 38.8% age ≥65) patients with newly diagnosed hypertension. Age and sex adjusted incidence of hypertension was highest in South Asian patients and lowest in Chinese patients. Compared with white patients, South Asian and Chinese patients had a lower mortality (adjusted HR (aHR) 0.91 and 0.66) and risk of cardiovascular disease outcomes (aHR 0.94 and 0.49). Compared to men, women had significantly lower mortality (aHR: 0.83 for Chinese, 0.78 for South Asian and 0.77 for white) and cardiovascular disease outcomes (0.72 for Chinese, 0.63 for South Asian and 0.65 for white).
Conclusions South Asian patients had higher rates of hypertension compared to the other ethnic groups. South Asian and Chinese patients had a lower risk of death and developing cardiovascular outcomes compared to whites. Women with hypertension have a better prognosis than men regardless of ethnicity.