The prevalence of hypertension in multiple sclerosis based on 37 million electronic health records from the United States

Abstract

Background and purposeHypertension (HTN) is a common comorbidity in multiple sclerosis (MS), and it significantly contributes to adverse outcomes. Unfortunately, the distribution of HTN in persons with MS has not been well characterized, and prior estimates have primarily relied on modest sample sizes. The objective of this study was to robustly describe the distribution of HTN in the MS population in comparison to the non‐MS population with considerations for age, sex, and race. To date, this is the largest investigation of its kind.MethodsWe conducted a cross‐sectional study of 37 million unique electronic health records available in the IBM Explorys Enterprise Performance Management: Explore database (Explorys) spanning the United States. This resource has previously been validated for use in MS. We evaluated the prevalence of HTN in MS (N = 122 660) and non‐MS (N = 37 075 350) cohorts, stratifying by age, sex, and race.ResultsThe prevalence of HTN was significantly greater among those with MS than among those without MS across age, sex, and race subpopulations, even after adjusting for age and sex. HTN was 25% more common in MS. In both MS and non‐MS cohorts, the prevalence of HTN progressively increased with age and was higher in Black Americans and in males.DiscussionThis study demonstrated that HTN is significantly more common in the MS population compared to the non‐MS population, irrespective of sex and race. Because HTN is the leading global risk factor for disability and death, these results emphasize the need for aggressive screening for, and management of, HTN in the MS population.

Impact of comorbidities on the disability progression in multiple sclerosis

“…15 Higher prevalence of hypertension in PwMS compared to MS-free individuals and its increasing tendency during MS was also confirmed in the US study, based on the electronic health records of 37 million US citizens. 16 In line with our findings, Marrie et al showed that the presence of one or more vascular comorbidities (hypertension, hypercholesterolemia, diabetes, heart disease, and peripheral vascular disease) in PwMS was associated with a 6-year faster progression to a disability level requiring an ambulatory assistance. 4 An increased risk for disability progression was also observed if one or more vascular comorbidities were present at the time of MS diagnosis and the risk increased with a rising number of vascular comorbidities.…”

“…In a recent Australian study, it was observed that the highest increase among comorbidities in the prevalence from disease onset to the time of investigation (on average 20.5 years after the disease onset) was found for hypertension (+21.9%) and hypercholesterolemia (+16.3%) 15 . Higher prevalence of hypertension in PwMS compared to MS‐free individuals and its increasing tendency during MS was also confirmed in the US study, based on the electronic health records of 37 million US citizens 16 . In line with our findings, Marrie et al showed that the presence of one or more vascular comorbidities (hypertension, hypercholesterolemia, diabetes, heart disease, and peripheral vascular disease) in PwMS was associated with a 6‐year faster progression to a disability level requiring an ambulatory assistance 4 .…”

Age of hypertension onset in multiple sclerosis patients

“…Forty-one percent of persons with MS in the United States may have a HTN diagnosis, including 53% of Black Americans with MS. 3 Unfortunately, HTN is associated with adverse MS outcomes, which is likely dependent on the evolution of overlapping and/or distinct disease processes-this presents challenges for characterizing their relationship. However, there are opportunities to advance our understanding of key aspects, such as HTN AAO in those with/at risk for MS and those without MS. We observed no differences in HTN AAO by MS status, nor differences by sex or in White or Black Americans.…”

“…1,2 In multiple sclerosis (MS) patients, the burden of HTN and CVD is significantly higher than that in non-MS patients. 3,4 CVD is also a leading cause of death in MS, and these CVD mortality rates are much higher than those in the general population. 5 Given the relationships between HTN and CVD in MS, HTN AAO on CVD and CVD mortality, and CVD mortality in MS, we hypothesized that there may be an association between HTN AAO in MS, which may in part explain the elevated risk for CVD mortality.…”

Association between rs20456 and rs6930913 of Kinesin-Like Family 6 and Hypertension in a Chinese Cohort

“…Essential hypertension (EH), accounting for 90–95% of the total hypertension cases [ 1 ], is a polygenic disease. Genetic alterations, environmental factors, and gene-environmental interactions are supposed to have a key role in the etiology of EH [ 2 ].…”