All ETDs from UAB

Advisory Committee Chair

Paul Muntner

Advisory Committee Members

Norrina B Allen

April P Carson

Cora E Lewis

David T Redden

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Public Health


The prevalence of healthy behaviors associated with optimal blood pressure (BP) levels and reduced risk for target-organ damage and cardiovascular disease (CVD) is lower in blacks compared with whites. Randomized controlled trials provide evidence that if healthy behaviors are maintained over the lifespan, including normal body weight, moderate physical activity, limited alcohol intake, limited sodium intake, adequate potassium intake and a rich diet of fruits and vegetables and low in high-fat dairy and saturated and total fat, then high BP may be preventable. The goal of this dissertation was to assess racial differences in the maintenance of healthy behaviors and the association of maintaining health behaviors with cumulative BP burden and target-organ damage among 5,115 young black and white adults followed into middle-age using data from the prospective, population-based Coronary Artery Risk Development in Young Adults (CARDIA) study. The results indicate whites had a higher likelihood than blacks for maintaining optimal body mass index (BMI), physical activity, Dietary Approaches to Stop Hypertension (DASH) diet adherence and ≥4 optimal behaviors and lower probability for maintaining optimal alcohol intake between 18 and 50 years old. Maintaining optimal smoking status did not differ. Blacks had a higher BP burden, higher left ventricular mass (LVM) and higher probability of left ventricular hypertrophy (LVH) than whites. Maintaining versus not maintaining optimal BMI was the only behavior associated with sustaining lower cumulative BP burden from young into middle-age adulthood. Whereas optimal physical activity at baseline was associated with less change in LVM by middle-age in whites only, maintaining optimal BMI was associated with lower incidence of LVH in blacks and whites. Maintaining optimal smoking status, physical activity, alcohol intake, DASH diet adherence and at least four optimal behaviors were not associated with BP burden and incident LVH. Not maintaining optimal BMI explained a small amount of the excess odds blacks have for higher BP burden than whites. In conclusion, while many factors contribute to the development of CVD, the results herein highlight the important role of maintaining optimal BMI to minimize cumulative BP burden from early adulthood into middle age and risk for LVH by middle-age.

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