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AMA Study Finds Link Between Confinement and Hypertension

An American Medical Association (AMA) study found that incarceration is associated with future hypertension and left ventricular hypertrophy (LVH) among young adults. Untreated, this can lead to increased cardiovascular disease (CVD) mortality.

Researchers conducted “a longitudinal investigation of CVD risk factors and subclinical coronary disease in a population of black and white men and women aged 18 to 30 years at baseline in 1985-1986…. The study enrolled 5,115 young adults, who were recruited from 4 U.S. cities.” Only 4,350 subjects who participated in the study for at least five years were included in the analysis.

Seven percent of participants (288) reported having been incarcerated. “Black men and less-educated participants were most likely to have a history of prior incarceration.” Additionally, former prisoners “were more likely to report family earnings below 200% of the federal poverty line, smoking, illicit drug use, and excessive alcohol consumption compared with those without incarceration history.”

The study “found that a history of incarceration is associated with a significantly elevated risk of future hypertension and with LVH.” Three to five years after incarceration, those 23 to 35 years old had a 12% incidence of hypertension, compared with 7% among those without an incarceration history. “Subgroups with the highest rate of incarceration – black men and less educated participants – showed significant associations between incarceration and incident hypertension.”

Researchers found that increased substance abuse or obesity, and lower socioeconomic status did not account entirely for the hypertension risk among former prisoners. Rather, the increase may be due to “increased hostility or stress among individuals with prior incarceration that has been shown to increase the risk for hypertension and ultimately atherosclerosis. The stress of incarceration may increase catecholamine or stress hormone levels that lead to hypertension, or incarceration may cause lasting dysregulation of these hormones that might lead to the development of hypertension later in life at faster rates.

Study results “suggest that hypertension and associated LVH in young former inmates may contribute to the previously observed increased risk of CVD death after their release.”

Only 17 percent of former prisoners, compared with 41 percent of non-incarcerated participants, obtained medical treatment for their hypertension seven years into the study. Those with an incarceration history “were less likely to have insurance, access to health care, or be using antihypertensive medications. Current and former inmates with chronic dis-eases such as hypertension typically fall at the intersection of 2 poorly functioning health care systems: the correctional health care system and the public safety net health care system,” researchers found. “Neither health care system is well equipped to take care of the growing population of individuals with chronic medical conditions who cycle in and out of both systems. Ninety percent of those released from jail are uninsured and lack financial resources to pay for their medical care in the community.”

Researchers suggested that “detention in jail, where health care is constitutionally guaranteed, may present a prime opportunity to screen soon-to-be r3eleased inmates for hypertension and to link inmates with chronic conditions to health care services in the community on release.”

“While incarceration is not a traditional risk factor for CVD, our results suggest that a history of incarceration should be understood as part of the risk profile for the development of hypertension and LVH in young adults,” wrote researchers. Further study was recommended as to “the true effect of the type, frequency and intensity of incarceration on the development of hypertension, especially given the high rates of recidivism nationwide.”

See: Arch Intern Med/Vol. 169 (No. 7), Apr. 13, 2009,

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