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Incarceration during young adulthood linked with subsequent hypertension, left ventricular hypertrophy, research shows

Tuesday, May 19 2009 | Comments

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What's This? Young adults who are incarcerated have an increased risk for incident hypertension and left ventricular hypertrophy later on, the CARDIA study indicates.

Since incarceration has been associated with elevated cardiovascular disease mortality, investigators sought to find risk factors and mechanisms for this link. Data were obtained from CARDIA, a longitudinal cohort study initiated in 1985-1986 among black and white subjects aged 18 to 30 years who resided in 1 of 4 U.S. cities. A total of 4,350 participants had baseline and follow-up examinations through year 5.

Overall, 288 subjects had been incarcerated during a 3-year period of young adulthood, and this incarceration history was more common among black men and people with less education (<=high school education).

Results showed that among participants without hypertension at baseline, the odds of them developing incident hypertension by year 5 were greater in those who had been inmates than in those who had not (12% vs 7%; unadjusted odds ratio [OR], 1.7; 95% CI, 1.2-2.6). This association persisted after adjusting for age, sex, race, drug and alcohol use, and poverty (adjusted OR, 1.6; 95% CI, 1.0-2.6).

The relationship was particularly pronounced among black subjects (adjusted OR, 1.9; 95% CI, 1.1-3.5) and those with less education (adjusted OR, 4.0; 95% CI, 1.0-17.3).

Also, a higher average left ventricular mass index and left ventricular hypertrophy occurred significantly more often in subjects with an incarceration history than in those who had not served time (P<.001 and P=.005, respectively). The adjusted odds of left ventricular hypertrophy exhibited a trend of being elevated in former inmates (2.7; 95% CI, 0.9-7.9; P=.08); the association was significant when adjusted analyses were restricted to black people and those with less schooling (P=.03 and P=.04).

Cholesterol levels and diabetes rates did not differ according to incarceration history, but former inmates with hypertension were more likely to report barriers to health care as well as lack of hypertension treatment than were patients without incarceration history.

"Physicians working in communities where incarceration is highly prevalent should consider screening for a history of incarceration because it may provide information about the future risk of hypertension and associated end-organ damage, as well as the risk of discontinuity in health care or treatment," the researchers advised. "Moreover, detention in jail, where health care is constitutionally guaranteed, may present a prime opportunity to screen soon-to-be released inmates for hypertension and to link inmates with chronic conditions to health care services in the community on release." (Wang EA, et al. Arch Intern Med 2009;169:687-693.)

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