All ETDs from UAB

Advisory Committee Chair

Emily Levitan

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Public Health


In the United States, 44% of adult women >18 years have hypertension. Although non-Hispanic Black adults were more likely to be aware of and treated for hypertension compared to non-Hispanic White adults, Black individuals had the highest prevalence of uncontrolled hypertension. Persons living with HIV have a higher prevalence of hypertension, which is a major modifiable risk factor for cardiovascular disease. Similar to the geographic distribution of hypertension in the US, people living in the South have higher incidence of both hypertension and HIV diagnoses compared to other US regions. Furthermore, accurate diagnosis of hypertension and initiation of treatment is vital among the 42% of US adults who have obesity. Overestimation of blood pressure can occur when the standard brachial cuff used on the upper arm is too small. An alternative approach in capturing blood pressure in individuals with obesity is the use of forearm radial cuffs, which is significantly higher than brachial blood pressure. The goal of this dissertation was to (1) evaluate cross-sectional associations between race and ethnicity, as well as HIV status, and prevalence, awareness, treatment, and control of hypertension among women in the South participating in the Women’s Interagency HIV Study; (2) prospectively examine incidence of hypertension and hypertension awareness, treatment, and control among women in the same cohort; (3) compare and harmonize radial and brachial blood pressure among participants with mid-arm circumference >40 cm in select Multicenter AIDS Cohort Study/Women’s Interagency HIV Study-Combined Cohort Study sites. I found non-Hispanic Black women had higher prevalence of hypertension and slower time to controlled hypertension compared to non-Hispanic White and Hispanic women. Among women with hypertension, those living with HIV were more likely to use antihypertensive medication and have faster time to treatment compared to women living without HIV. Among participants with obesity, prevalent hypertension increased, and control decreased based on estimated radial blood pressure compared to measured brachial blood pressure. Due to the elevated burden of comorbidities and increased access to care among people living with HIV, the patterns of hypertension prevalence, treatment, and control may differ from prior studies, especially among those with large arm circumference.

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