All ETDs from UAB

Advisory Committee Chair

Emily B Levitan

Advisory Committee Members

Nancy E Dunlap

Raegan W Durant

George Howard

Paul Muntner

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Public Health


Heart failure (HF) is the inability of the heart to meet the perfusion needs of the body. HF is a leading contributor to the burden of cardiovascular disease (CVD) and remains a public health concern. Hypertension is a major modifiable risk factor for the prevention and management of HF. Hypertension develops earlier, is less controlled, and has a stronger association with some CVD and renal outcomes among blacks versus whites. These disparities may extend to HF. In addition, adults with HF often have complex treatment regimens due to multimorbidity, making medication adherence an issue. The goal of this dissertation was to examine the associations of hypertension, duration of hypertension and blood pressure (BP) control with incident HF in black and white adults from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Additionally, medication-taking behaviors and perceptions were assessed among REGARDS participants with HF, particularly focus on beta-blockers (BBs). Among 25,770 adults the prevalence of hypertension was high and associated with an increased risk of incident HF. Compared to normotension, adults with hypertension ≥ 10 years and those with uncontrolled BP had the highest risk of developing incident HF. However even among adults with shorter duration of hypertension and well-controlled BP there was an increased risk for incident HF. There was no evidence of statistical differences in the association between hypertension and HF for black and white adults. Among adults with HF, nearly half were taking ≥ 10 prescription medications per day. A large proportion indicated that they do not miss any days in a month taking their pills and over 85% indicated a willingness to take an additional pill to prevent future healthcare encounters. In addition, many were taking a BB, and those who had a HF hospitalization were more likely to be aware of the HF-specific benefits of their BB. In conclusion, primordial prevention and therapeutic management of hypertension are important in reducing HF risk. Among those with HF, many adults are willing to try new therapies to better manage their condition and may benefit from better patient education about the HF-specific benefits of their therapy.

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