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. 2021 May 6;34(9):956–962. doi: 10.1093/ajh/hpab068

Temporal Trends in Hypertension Death Rate in Mississippi, 2000–2018

Vincent L Mendy 1,✉, Tawandra Rowell-Cunsolo 2, Meghan Bellerose 3, Rodolfo Vargas 4, Lei Zhang 4, Byambaa Enkhmaa 5
PMCID: PMC8457431  PMID: 33954415

Abstract

BACKGROUND

In Mississippi, hypertension as a leading cause of death moved from 15th in 2000 to 11th in 2018, but research on temporal trends is limited. We examined temporal trends in hypertension-related mortality among Mississippi adults by age, sex, and race.

METHODS

We extracted data on the number of deaths due to hypertension among adults aged 45 or older annually from 2000 to 2018 from Mississippi Vital Statistics. We used underlying cause-of-death codes from the International Classification of Diseases, Tenth Revision to identify hypertension deaths. We calculated the annual percentage change (trend segment) and average annual percentage change (AAPC) in age-adjusted hypertension death rates from 2000 to 2018 and examined differences in the AAPC by age, sex, and race.

RESULTS

From 2000 through 2018, the age-adjusted hypertension death rate increased annually by 3.0% (AAPC 3.0%, 95% confidence interval, 1.9%–4.0%) with 3 distinct time periods. There was an average annual increase in age-adjusted hypertension death rates for all subgroups, i.e., men, women, Blacks, Whites, White females, Black males, and White males. The highest magnitude of increase was among those aged 45–64 years (AAPC 6.0%), men (AAPC 4.5%), Whites (AAPC 3.5%), and White men (AAPC 6.2%) compared with other age groups, women, Blacks, and Black men, respectively.

CONCLUSIONS

For nearly 2 decades, there was an increase in age-adjusted hypertension death rates among Mississippi adults aged 45 years or older. Blood pressure lowering interventions that target hypertensive adults are needed.

Keywords: blood pressure, hypertension, Mississippi, mortality, trends

Graphical Abstract

Graphical Abstract.

Graphical Abstract

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Trends in the overall age-adjusted hypertension death rate among Mississippi adults aged 45 or older, 2000 through 2018.

Hypertension is an important independent risk factor for cardiovascular events, premature death, and disability.1–5 Among US adults, hypertension is one of the leading causes of death2 and a recent national study reported an increasing trend in hypertension-related cardiovascular disease (CVD) death rates.6 While these increasing trends are seen in all US regions,6 the southern region of the United States, specifically, has experienced significant increases in the prevalence of hypertension from 2011 to 2015.7

In addition to bearing a disproportionate burden of hypertension, the US south also faces substantial hypertension prevalence disparities.6 For instance, in 2017, an estimated 926,749 (40.8%) Mississippi adults aged 18 years or older reported a diagnosis of hypertension, defined as being told by a doctor, nurse, or other health professional that they had high blood pressure.8 Racial and ethnic minorities comprise a higher proportion of hypertensive Mississippians.9 In 2018, age-adjusted hypertension death rates in African Americans were 2.4 times higher than those among Whites in Mississippi.10 In the Jackson Heart Study (JHS), the largest11 investigation of CVD causes in African Americans, which includes the tri-counties of Hinds, Madison and Rankin in Mississippi,12 62.9% of the cohort met the definition for having hypertension.13 Among the JHS participants whose hypertension was treated with medications, only 66.4% had controlled blood pressure. In Mississippi, hypertension as a leading cause of death moved from 15th in 2000 to 11th in 2018.10 The lower rate of hypertension control among African Americans is a primary cause of disparities in CVD.13,14

Although hypertension-related CVD death rates are increasing in southern US regions,6,7 temporal trends in race-, sex-, and age-adjusted mortality due to hypertension have not been examined in Mississippi. To address this gap, our goal was twofold: (i) to calculate the annual percentage change (APC, trend segment) and the average annual percentage change (AAPC) in age-adjusted hypertension death rates from 2000 to 2018 among Mississippi adults aged 45 years or older, and (ii) to examine differences in the AAPC by sex, age, and race. A better understanding of mortality trends due to hypertension could be used to develop targeted prevention programs to reduce hypertension-associated disparities in Mississippi. Identifying trends associated with hypertension-related mortality could also inform more coordinated state-level responses to address a persistent public health challenge.

METHODS

Data collection and statistical analyses

We extracted data on the number of deaths due to hypertension among adults aged 45 years or older for each year from 2000 to 2018 from Mississippi Vital Statistics.10 In 2018, 96.6% of deaths due to hypertension in Mississippi occurred among people aged 45 years or older, therefore only decedents age 45 years and over were included in this analysis.15 We used underlying cause-of-death codes from the International Classification of Diseases, Tenth Revision (ICD-10) to identify hypertension deaths; we included all cases with codes I10–I15.10 We then used Mississippi population census counts to calculate age-adjusted hypertension death rates and standard errors for the overall population, by age groups (45–64, 65–74, 75–84, and ≥85 years), race (non-Hispanic Black or non-Hispanic White), sex (male or female), and race and sex (non-Hispanic Black male and female or non-Hispanic White male and female) using SAS version 9.4 (SAS Institute). We adjusted for age by using the direct method and the 2000 US standard projected population.16 We then exported age-adjusted hypertension death rates and standard errors to the U.S. Surveillance, Epidemiology, and End Results (SEER) Joinpoint software (version 4.7.0.0.) https://surveillance.cancer.gov/joinpoint/)17 to calculate the AAPC in hypertension death rates for the overall Mississippi population as well as by race, sex, and a combination of race and sex. We restricted analyses to non-Hispanic Black and non-Hispanic White Mississippians; these racial groups accounted for 96.9% of the state’s population in 2018.10 Joinpoint regression analysis identifies trend breaks (joinpoints) or points of significant change in a trend. This analysis identified periods with distinct log-linear trends in hypertension death rates.18 Using the Bayesian information criterion to select the most parsimonious model with the best fit, we specified a maximum of 3 joinpoints.18–20 We used the slopes of the models to calculate the APC for each trend segment and the AAPC (the weighted average of the APCs).16 For each AAPC, we calculated 95% confidence intervals (CIs) and considered statistically different from 0 at P values less than 0.05. The Jackson State University Institutional Review Board approved the study.

RESULTS

The overall age-adjusted hypertension death rate increased by 55.4% from 2000 (82.8 per 100,000 population) to 2018 (138.2 per 100,000 population) with a statistically average annual increase of 3.0% (AAPC 3.0%, 95% CI, 1.9%–4.0%) (Table 1). This period includes 3 different segments: in the first segment (2000–2005), the overall rate increased by 5.3% (95% CI, 2.6%–8.2%) per year, no statistically annual increase in the second segment (2005–2014), and statistically annual increase by 5.4% (95% CI, 2.5%–8.5%) in the third segment (2014–2018).

Table 1.

Trends in age-adjusted hypertension death rates among Mississippi adults aged ≥45 years, 2000–2018

No. of hypertension deaths (age-adjusted rate)a AAPC (95% CI)b Trend segment 1 Trend segment 2 Trend segment 3
Characteristic 2000 2018 2000–2018 Years APCc (95% CI) Years APC (95% CI) Years APC (95% CI)
Overall 781 (82.8) 1,675 (138.2) 3.0e (1.9 to 4.0) 2000–2005 5.3e (2.6 to 8. 2) 2005–2014 0.6 (−0.5 to 1.7) 2014–2018 5.4e (2.5 to 8.5)
Sex
 Male 276 (77.2) 805 (156.7) 4.5e (3.0 to 6. 0) 2000–2004 9.7e (3.9 to 15.9) 2004–2014 1.2 (−0.1 to 2.5) 2014–2018 7.7e (3.8 to 11.7)
 Female 505 (82.9) 870 (121.7) 1.4e (0.9 to 1.9) 2000–2018 1.4e (0.9 to 1.9) — f — f — f — f
Age group, yearsd
 45–64 119 (19.5) 425 (56.3) 6.0e (4.0 to 8.1) 2000–2007 10. 0e (7. 0 to 13.1) 2007–2011 −1.4 (−9.0 to 6.8) 2011–2018 6.6e (4.5 to 8.6)
 65–74 136 (73.2) 350 (124.7) 3. 4e (0.3 to 6.7) 2000–2007 5.8e (1.8 to 9.9) 2007–2011 −5.2 (−17.0 to 8.2) 2011–2018 6.4e (3.3 to 9.5)
 75–84 224 (194.9) 366 (258.6) 1. 0e (0.2 to 1.7) 2000–2018 1. 0e (0.2 to 1.7) — f — f — f — f
 ≥85 302 (704.1) 534 (1,020.2) 1.3e (0.5 to 2.1) 2000–2018 1.3e (0.5 to 2.1) — f — f — f — f
Race
 Black 379 (150.0) 678 (197.6) 1.4e (0.2 to 2.6) 2000–2005 5.4e (1.1 to 9.9) 2005–2018 −0.1 (−0.9 to 0.7) — f — f
 White 400 (59.0) 982 (114.5) 3.5e (2.3 to 4.7) 2000–2015 2.4e (1.7 to 3.2) 2015–2018 8.9e (1.7 to 16.6) — f — f
Race and sex
 Black female 226 (142.2) 355 (309.2) 3.7 (−0.1 to 7.7) 2000–2007 3.0 (−0.8 to 7. 0) 2007–2010 20.2 (−4.5 to 51.2) 2010–2018 −1.3 (−3.4 to 0.9)
 White female 278 (61.7) 509 (100.2) 2.2e (1.7 to 2.7) 2000–2018 2.2e (1.7 to 2.7) — f — f — f — f
 Black male 153 (278.7) 323 (509.4) 3.4e (2.3 to 4.5) 2000–2018 3.4e (2.3 to 4.5) — f — f — f — f
 White male 122 (48.2) 473 (130.6) 6.2e (4.2 to 8.1) 2000–2004 12e (4.1 to 20.4) 2004–2014 2.0e (0.3 to 3.6) 2014–2018 11.3e (6.6 to 16.2)
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Abbreviations: AAPC, average annual percentage change; APC, annual percentage change; CI, confidence interval.

aPer 100,000 population, adjusted to the 2000 US standard population with age groups 45–64, 65–74, 75–84, and ≥85 years.

bThe AAPC is a weighted average of the APCs calculated by joinpoint regression.

cThe APC is based on age-adjusted rates to the 2000 US standard population.

dPer 100,000 population, crude rates.

eAAPC, APC is significantly different from 0.

fDashes indicate that the best-fit joint model did not include that trend segment.

Hypertension-related death rates by sex

Among men, the age-adjusted hypertension death rate increased by 79.5% from 2000 (77.2 per 100,000 population) to 2018 (156.7 per 100,000 population) with an AAPC of 4.5% (95% CI, 3.0%–6.0%). The trends in this group consist of 3 different segments: an annual increase by 9.7% (95% CI, 3.9%–15.9%) during the first segment (2000–2004), no APC in the second segment (2004–2014), and an annual increase by 7.7% (95% CI, 3.8%–11.7%) in the third segment (2014–2018). For women, the age-adjusted hypertension death rate increased by 38.8% from 2000 (82.9 per 100,000 population) to 2018 (121.7 per 100,000 population), with an average annual increase of 1.4% (AAPC 1.4%, 95% CI, 0.9%–1.9%). In contrast to the findings in men, there were no distinct segments with differing results among women during this period (Table 1).

Hypertension-related death rates by age

By age groups, from 2000 to 2018, the hypertension death rate increased by 188.7% (19.5–56.3 per 100,000) among those 45–64 years; by 70.4% (73.2–124.7 per 100,000) among those 65–74 years, by 31.7% (194.9–258.6 per 100,000) among those 75–84 years and by 44.9% (704.1–1,020.2 per 100,000) among those 85 years or older. Average annual changes in the hypertension death rate increased in all age groups: 45–64 years: AAPC 6.0% (95% CI, 4.0%–8.1%); 65–74 years: AAPC 3.4% (95% CI, 0.3%–6.7%); 75–84 years: AAPC 1.0% (95% CI, 0.2%–1.7%); and 85 years or older: AAPC 1.3% (95% CI, 0.5%–2.1%) from 2000 to 2018. However, distinct segments occurred only in those aged 45–64 and 65–74 years. For those aged 45–64 years, in the first segment (2000–2007), the death rate increased by 10.0% (95% CI, 7.0%–13.1%) annually, there was no statistically significant increase in the second segment (2007–2011). However, the death rate increased by 6.6% (95% CI, 4.5%–8.6%) annually in the third segment (2011–2018). Similarly, for those aged 65–74 years, the death rate increased by 5.8% (95% CI, 1.8%–9.9%) annually in the first segment (2000–2007), did not increase in the second segment (2007–2011), but increased by 6.4% (95% CI, 3.3%–9.5%) annually in the third segment (2011–2018).

Hypertension-related death rates by race

Among Blacks, the age-adjusted hypertension death rate increased by 47.6% from 2000 (150.0 per 100,000 population) to 2018 (197.6 per 100,000 population) with an average annual increase of 1.4% (AAPC 1.4%, 95% CI, 0.2%–2.6%). Among Whites, the age-adjusted hypertension death rate increased by 55.5% from 2000 (59.0 per 100,000 population) to 2018 (114.5 per 100,000 population) with an average annual increase of 3.5% (AAPC 3.5%, 95% CI, 2.3%–4.7%). There were 2 distinct segments for both racial groups. Among Blacks, the rates increased annually by 5.4% (95% CI, 1.1%–9.9%) during the first segment (2000–2005) but did not increase during the second segment (2005–2018). In contrast, among Whites, the rates increased annually by 2.4% (95% CI, 1.7%–3.2%) in the first segment (2000–2015) and by 8.9% (95% CI, 1.7%–16.6%) in the second segment (2015–2018).

Hypertension-related death rates by race and sex

Among Black women, the age-adjusted hypertension death rate increased by 167% from 2000 (142.2 per 100,000 population) to 2018 (309.2 per 100,000 population); however, there was no significant average annual change during this period (AAPC 3.7%, 95% CI, −0.1% to 7.7%). Among White women, the age-adjusted hypertension death rate increased by 38.5% from 2000 (61.7 per 100,000 population) to 2018 (100.2 per 100,000 population) with an average annual increase of 2.2% (AAPC 2.2%, 95% CI, 1.7%–2.7%). Among Black men, the age-adjusted hypertension death rate increased by 230.7% from 2000 (278.7 per 100,000 population) to 2018 (509.4 per 100,000 population) with an average annual increase of 3.4% (AAPC 3.4%, 95% CI, 2.3%–4.5%). Among White men, the age-adjusted hypertension death rate increase by 82.4% from 2000 (48.2 per 100,000 population) to 2018 (130.6 per 100,000 population) with an average annual increase of 6.2% (AAPC 6.2%, 95% CI, 4.2%–8.1%). During this period, distinct segments occurred in Black women and White men only. For Black women, there were no significant annual changes in the 3 segments, respectively, 2000–2007 (APC 3.0%, 95% CI, −0.8% to 7.0%), 2007–2010 (APC 20.2%, 95% CI, −4.5% to 51.2%), and 2010–2018 (APC −1.3%, 95% CI, −3.4% to 0.9%). For White men, there was an annual increase of 12% (95% CI, 4.1%–20.4%) in the first segment (2000–2004), 2.0% in the second segment (95% CI, 0.3%–3.6%), and 11.3% (95% CI, 6.6%–16.2%) in the third segment. Figure 1 shows trends in hypertension death rates by sex and race.

Figure 1.

Figure 1.

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Trends in the age-adjusted hypertension death rate among Mississippi adults aged 45 or older by race and sex, 2000 through 2018.

DISCUSSION

In this study for nearly 2 decades (2000–2018), there was a 3.0% average annual increase in age-adjusted hypertension death rate among Mississippi adults aged 45 years or older. Three distinct segments in this time period were identified: during the first segment (2000–2005), hypertension death rates increased annually; there were no significant annual changes during the second segment (2005–2014), but the rate again increased annually during the third segment (2014–2018). These overall results and our age-, sex-, and race-specific findings are in line with those of a national study that demonstrated significant increases in hypertension-related mortality among US adults during 2000–2013.15

First, in our study, the overall average annual increase in hypertension death rate was 3.2 times greater in men than in women. Likewise, using data from the National Vital Statistics System from 2000 through 2013, Kung and Xu15 found that the hypertension-related death rate was higher for men than women in all age groups aside from those aged 85 years and over.15 Greater healthcare utilization among women21 and biological factors, including anti-inflammatory immune profile in females22,23 have been documented to explain the gender differences in hypertension rate.

Second, average annual increases were highest among those aged 45–64 years. Average annual increases in hypertension death rate were 1.8, 6, and 4.6 times greater among people aged 45–64 years compared with those aged 65–74, 75–84, and 85 years or older, respectively. Middle-age adults (45–64 years) had a greater relative change in hypertension death rate compared with their counterparts but also a lower hypertension death rate. Absolute increase in mortality may be larger in older adults while the relative change was larger in those 45–64 years. These findings suggest older Mississippians and those aged 45–64 should be prioritized for prevention and treatment for hypertension. Management strategies for hypertension in older adults must be individualized and include degree of frailty, increasing complex medical comorbidities, and psychosocial factors.24 Lifestyle modifications in middle-age Mississippians are needed to prevent hypertension with age.24 In the national study by Kung and Xu,15 hypertension-related death rate increased for both sexes aged 45–64 and 85 or older.

Third, we observed that the average annual increases in hypertension death rates were evident in all sex–race groups except for Black women. This finding is consistent with the results in a 2019 national study that demonstrated increases in hypertension death rates in most sex–race groups except in Black women.25 Particularly, we found that the greatest increase was in White men. Similarly, Rethy et al.26 observed that the greatest increase in hypertension-related CVD deaths within a national dataset between 2000 and 2018 occurred among White men.26 In a study on obesity among Mississippi adults, we found a significant increase in the prevalence of extreme obesity (body mass index 40.0 or greater) only among adult White Mississippians (APC, 2.6%).27 Higher grades of obesity are associated with all-cause mortality.28 Models have shown that the decline in CVD and stroke mortality has been fueled by rapid progress in both prevention and treatment strategies, including precipitous declines in cigarette smoking and improvements in hypertension treatment and control.29,30 However, the rising trends in obesity and diabetes have contributed to the increase in hypertension-related CVD mortality rates.15,31 Hypertension is the most common risk factor for stroke.32 In Mississippi, we found that the overall age-adjusted stroke death rate first declined by 5.0% annually year from 2000 to 2008 but did not increase annually from 2008 to 2016.33

Even though the percent change in mortality is higher among White Americans, particularly in White men, the age-adjusted hypertension mortality rate (as shown in Figure 1) remained substantially higher for Black men and Black women than White men and White women between 2000 and 2018. Ongoing racial disparities in hypertension mortality may be due to increases in obesity27 and racial discrimination in Mississippi. Obesity rates among Blacks in Mississippi have grown by 1.9% annually between 2001 and 2010.27 In 2018, obesity rates in Mississippi were higher among Blacks (45.7%) compared with Whites (36.2%).34 In the JHS, lifetime discrimination and burden of discrimination were associated with a greater hypertension prevalence.35 Persistent higher rates of obesity among Black Americans are largely due to structural racism that has made it difficult for Black Americans to access healthcare services and resources, which in turn increases the likelihood of experiencing obesity and/or other chronic diseases.36

The study has limitations and strengths. First, reliance on death certificates may introduce bias because of the potential misclassification of the primary cause of death.37 Second our study used the ICD-10 codes, which may be subject to misclassification.26 Third, Mieno et al. found that the sensitivity and specificity for the underlying cause of death for diseases of the circulatory system was 71.1% and 97.9%, respectively.37 However, race and ethnicity reporting on death certificates has been validated and deemed adequate for both White and Black populations.38 The major strength of the study was the use of nearly 2 decades of statewide hypertension death rates, all of which were calculated using the same methods.

Overall, this study demonstrated that an increase in hypertension death rate occurred in Mississippi adults during 2000–2018. Average annual increases were highest in adults aged 45–64 years, Whites, and White men. The 2017 American College of Cardiology (ACC) and American Heart Association (AHA) guidelines outline recommendations for the prevention, detection, evaluation, and management of high blood pressure in adults.39 Such guidelines and evidence-based treatment approaches should be reviewed regularly during routine visits with healthcare providers. Discussions regarding hypertension management should include the benefits of blood pressure lowering, including significant reductions in both CVD40 and death risks.41 Clinical guidelines, including the above mentioned ACC/AHA guideline, are supported by studies demonstrating practical evidence-based ways of lowering high blood pressure and the health benefits of doing so.42,43 Mississippi adults, particularly those with the highest increase in hypertension-related death rates, could benefit from targeted interventions focused on high blood pressure prevention and management.

FUNDING

The work is partially funded by a small research project from NHLBI grant # R25HL105446 to Dr Mohamed Boutjdir.

ACKNOWLEDGMENTS

We would like to thank Mr Dick Johnson of the Mississippi State Department of Health.

DISCLOSURE

The authors declared no conflict of interest.

DATA AVAILABILITY

The data underlying this article are available from the Mississippi State Department of Health for researchers who meet the criteria for access to confidential data.

REFERENCES

  • 1. Wright JT Jr, Williamson JD, Whelton PK, Snyder JK, Sink KM, Rocco MV, Reboussin DM, Rahman M, Oparil S, Lewis CE, Kimmel PL, Johnson KC, Goff DC Jr, Fine LJ, Cutler JA, Cushman WC, Cheung AK, Ambrosius WT; SPRINT Research Group . A randomized trial of intensive versus standard blood-pressure control. N Engl J Med 2015; 373:2103–2116. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2. Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Shay CM, Spartano NL, Stokes A, Tirschwell DL, VanWagner LB, Tsao CW; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee . Heart disease and stroke statistics—2020 update: a report from the American Heart Association. Circulation 2020; 141:e139–e596. [DOI] [PubMed] [Google Scholar]
  • 3. Randolph TC, Greiner MA, Egwim C, Hernandez AF, Thomas KL, Curtis LH, Muntner P, Wang W, Mentz RJ, O’Brien EC. Associations between blood pressure and outcomes among blacks in the Jackson Heart Study. J Am Heart Assoc 2016; 5:e003928. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4. Stevens A, Courtney-Long E, Gillespie C, Armour BS. Hypertension among US adults by disability status and type, National Health and Nutrition Examination Survey, 2001–2010. Prev Chronic Dis 2014; 11:E139. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5. Zhou D, Xi B, Zhao M, Wang L, Veeranki SP. Uncontrolled hypertension increases risk of all-cause and cardiovascular disease mortality in US adults: the NHANES III Linked Mortality Study. Sci Rep 2018; 8:9418. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6. Nambiar L, LeWinter MM, VanBuren PC, Dauerman HL. Decade-long temporal trends in U.S. hypertension-related cardiovascular mortality. J Am Coll Cardiol 2020; 75:2644–2646. [DOI] [PubMed] [Google Scholar]
  • 7. Fang J, Gillespie C, Ayala C, Loustalot F. Prevalence of self-reported hypertension and antihypertensive medication use among adults aged ≥18 years—United States, 2011–2015. MMWR Morb Mortal Wkly Rep 2018; 67:219–224. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8. The Mississippi Behavioral Risk Factor Surveillance System. https://msdh.ms.gov/msdhsite/_static/31,0,110.html. Accessed 23 April 2020.
  • 9. Mendy VL, Vargas R, Ogungbe O, Zhang L. Hypertension among Mississippi workers by sociodemographic characteristics and occupation, behavioral risk factor surveillance system. Int J Hypertens 2020; 2020:2401747. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10. Mississippi Vital Statistics. The Mississippi STatistically Automated Health Resource System (MSTAHRS). http://mstahrs.msdh.ms.gov/. Accessed 23 April 2020.
  • 11. Jackson Heart Study (JHS). https://www.nhlbi.nih.gov/science/jackson-heart-study-jhs. Accessed 20 February 2020.
  • 12. Sempos CT, Bild DE, Manolio TA. Overview of the Jackson Heart Study: a study of cardiovascular diseases in African American men and women. Am J Med Sci 1999; 317:142–146. [DOI] [PubMed] [Google Scholar]
  • 13. Wyatt SB, Akylbekova EL, Wofford MR, Coady SA, Walker ER, Andrew ME, Keahey WJ, Taylor HA, Jones DW. Prevalence, awareness, treatment, and control of hypertension in the Jackson Heart Study. Hypertension 2008; 51:650–656. [DOI] [PubMed] [Google Scholar]
  • 14. Carnethon MR, Pu J, Howard G, Albert MA, Anderson CAM, Bertoni AG, Mujahid MS, Palaniappan L, Taylor HA Jr, Willis M, Yancy CW; American Heart Association Council on Epidemiology and Prevention; Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Functional Genomics and Translational Biology; and Stroke Council . Cardiovascular health in African Americans: a scientific statement from the American Heart Association. Circulation 2017; 136:e393–e423. [DOI] [PubMed] [Google Scholar]
  • 15. Kung HC, Xu J. Hypertension-related mortality in the United States, 2000–2013. NCHS Data Brief 2015; 193:1–8. [PubMed] [Google Scholar]
  • 16. Klein RJ, Schoenborn CA. Age adjustment using the 2000 projected U.S. population. Healthy People 2010 Stat Notes 2001; 20:1–10. [PubMed] [Google Scholar]
  • 17. National Cancer Institute, Division of Cancer Control and Population Sciences. Joinpoint Regression Program, Version 4.7.0.0. https://surveillance.cancer.gov/joinpoint/. Accessed 20 February 2020.
  • 18. Zhang NR, Siegmund DO. A modified Bayes information criterion with applications to the analysis of comparative genomic hybridization data. Biometrics 2007; 63:22–32. [DOI] [PubMed] [Google Scholar]
  • 19. Kim HJ, Fay MP, Feuer EJ, Midthune DN. Permutation tests for joinpoint regression with applications to cancer rates. Stat Med 2000; 19:335–351. [DOI] [PubMed] [Google Scholar]
  • 20. Mendy VL, Vargas R, Payton M, Sims JN, Zhang L. Trends in the stroke death rate among Mississippi adults, 2000–2016. Prev Chronic Dis 2019; 16:E21. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21. Everett B, Zajacova A. Gender differences in hypertension and hypertension awareness among young adults. Biodemogr Soc Biol 2015; 61:1–17. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22. Sandberg K, Ji H. Sex differences in primary hypertension. Biol Sex Differ 2012; 3:7. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23. Gillis EE, Sullivan JC. Sex differences in hypertension: recent advances. Hypertension 2016; 68:1322–1327. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24. Oliveros E, Patel H, Kyung S, Fugar S, Goldberg A, Madan N, Williams KA. Hypertension in older adults: assessment, management, and challenges. Clin Cardiol 2020; 43:99–107. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 25. Shah NS, Lloyd-Jones DM, O’Flaherty M, Capewell S, Kershaw KN, Carnethon M, Khan SS. Trends in cardiometabolic mortality in the United States, 1999–2017. JAMA 2019; 322:780–782. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 26. Rethy L, Shah NS, Paparello JJ, Lloyd-Jones DM, Khan SS. Trends in hypertension-related cardiovascular mortality in the United States, 2000 to 2018. Hypertension 2020; 76:e23–e25. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 27. Mendy VL, Vargas R, Cannon-Smith G, Payton M. Overweight, obesity, and extreme obesity among Mississippi adults, 2001–2010 and 2011–2015. Prev Chronic Dis 2017; 14:E49. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 28. Flegal KM, Kit BK, Orpana H, Graubard BI. Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA 2013; 309:71–82. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 29. Mensah GA, Wei GS, Sorlie PD, Fine LJ, Rosenberg Y, Kaufmann PG, Mussolino ME, Hsu LL, Addou E, Engelgau MM, Gordon D. Decline in cardiovascular mortality: possible causes and implications. Circ Res 2017; 120:366–380. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 30. Lackland DT, Roccella EJ, Deutsch AF, Fornage M, George MG, Howard G, Kissela BM, Kittner SJ, Lichtman JH, Lisabeth LD, Schwamm LH, Smith EE, Towfighi A; American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Quality of Care and Outcomes Research; Council on Functional Genomics and Translational Biology . Factors influencing the decline in stroke mortality: a statement from the American Heart Association/American Stroke Association. Stroke 2014; 45:315–353. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31. Sidney S, Quesenberry CP Jr, Jaffe MG, Sorel M, Nguyen-Huynh MN, Kushi LH, Go AS, Rana JS. Recent trends in cardiovascular mortality in the United States and public health goals. JAMA Cardiol 2016; 1:594–599. [DOI] [PubMed] [Google Scholar]
  • 32. Wajngarten M, Silva GS. Hypertension and stroke: update on treatment. Eur Cardiol 2019; 14:111–115. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 33. Mendy VL, Vargas R, Payton M, Sims JN, Zhang L. Trends in the stroke death rate among Mississippi adults, 2000–2016. Prev Chronic Dis 2019; 16:E21. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 34. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. BRFSS Prevalence & Trends Data [online]. https://www.cdc.gov/brfss/brfssprevalence/. 2015. Accessed 20 February 2020.
  • 35. Sims M, Diez-Roux AV, Dudley A, Gebreab S, Wyatt SB, Bruce MA, James SA, Robinson JC, Williams DR, Taylor HA. Perceived discrimination and hypertension among African Americans in the Jackson Heart Study. Am J Public Health 2012; 102(Suppl 2):S258–S265. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 36. Bleich SN, Ard JD. COVID-19, obesity, and structural racism: understanding the past and identifying solutions for the future. Cell Metab 2021; 33:234–241. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 37. Mieno MN, Tanaka N, Arai T, Kawahara T, Kuchiba A, Ishikawa S, Sawabe M. Accuracy of death certificates and assessment of factors for misclassification of underlying cause of death. J Epidemiol 2016; 26:191–198. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 38. Arias E, Heron M; National Center for Health Statistics, Hakes J; US Census Bureau . The validity of race and Hispanic-origin reporting on death certificates in the United States: an update. Vital Health Stat 2 2016; 172:1–21. [PubMed] [Google Scholar]
  • 39. Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC Jr, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA Sr, Williamson JD, Wright JT Jr. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2018; 71:e13–e115. [DOI] [PubMed] [Google Scholar]
  • 40. Ettehad D, Emdin CA, Kiran A, Anderson SG, Callender T, Emberson J, Chalmers J, Rodgers A, Rahimi K. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet 2016; 387:957–967. [DOI] [PubMed] [Google Scholar]
  • 41. Brunström M, Carlberg B. Association of blood pressure lowering with mortality and cardiovascular disease across blood pressure levels: a systematic review and meta-analysis. JAMA Intern Med 2018; 178:28–36. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 42. Zanchetti A, Thomopoulos C, Parati G. Randomized controlled trials of blood pressure lowering in hypertension: a critical reappraisal. Circ Res 2015; 116:1058–1073. [DOI] [PubMed] [Google Scholar]
  • 43. Ziv A, Vogel O, Keret D, Pintov S, Bodenstein E, Wolkomir K, Doenyas K, Mirovski Y, Efrati S. Comprehensive Approach to Lower Blood Pressure (CALM-BP): a randomized controlled trial of a multifactorial lifestyle intervention. J Hum Hypertens 2013; 27:594–600. [DOI] [PMC free article] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data underlying this article are available from the Mississippi State Department of Health for researchers who meet the criteria for access to confidential data.

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