Blood Pressure Trajectories Among Young Veterans: Differences By Sex, Race, And Ethnicity

Background: Veteran status (~6% of U.S. population) is an independent risk factor for cardiovascular disease (CVD). High blood pressure (BP) increases CVD risk for older Veterans. Less is known about BP levels and trajectories for younger Veterans. Objective: Assess sex- and racial/ethnic differences in longitudinal BP trajectories for young Veterans accessing the Veterans Affairs (VA) healthcare system. Methods: We used national 2001-2016 Veterans Health Administration data for Veterans who served in conflicts in Afghanistan and Iraq. Systolic (SBP) and diastolic (DBP) BP were collected from the first to most recent outpatient visit. Linear mixed effects models estimated annual rate of change in BP. Models adjusted for sociodemographic, behavioral, and clinical factors included a time*sex, time*race/ethnicity interaction term. Results: We included 764,652 Veterans (13% women; median age 29.5 years) with 14,788,864 BP measurements over a mean of 6.1 years. There was a significant interaction by sex and race/ethnicity ( P <0.0001). In sex-stratified models, women vs. men had lower initial SBP (113.3 vs 120.9) and DBP (70.1 vs 73.0), but women had a markedly rapid BP increase over time (SBP rate of change= 0.36 vs 0.10 mmHg/year; DBP = 0.46 vs 0.31; Figure ). For women, Non-Hispanic (NH) Black women had the highest initial BP and annual rate of change (SBP/DBP: 0.46/0.50). Conclusion: Younger Veterans’ have normal BP when ending military service, but there are sex, racial, and ethnic differences in BP patterns over time. NH Black women Veterans show the greatest rate of BP increase. Targeted interventions may be needed to reduce disparities in trajectories to reduce future CVD risk.