Document Detail

US trends in prevalence, awareness, treatment, and control of hypertension, 1988-2008.
MedLine Citation:
PMID:  20501926     Owner:  NLM     Status:  MEDLINE    
CONTEXT: Hypertension is a major risk factor for cardiovascular disease and treatment and control of hypertension reduces risk. The Healthy People 2010 goal was to achieve blood pressure (BP) control in 50% of the US population.
OBJECTIVE: To assess progress in treating and controlling hypertension in the United States from 1988-2008.
DESIGN, SETTING, AND PARTICIPANTS: The National Health and Nutrition Examination Survey (NHANES) 1988-1994 and 1999-2008 in five 2-year blocks included 42 856 adults aged older than 18 years, representing a probability sample of the US civilian population.
MAIN OUTCOME MEASURES: Hypertension was defined as systolic BP of at least 140 mm Hg and diastolic BP of at least 90 mm Hg, self-reported use of antihypertensive medications, or both. Hypertension control was defined as systolic BP values of less than 140 mm Hg and diastolic BP values of less than 90 mm Hg. All survey periods were age-adjusted to the year 2000 US population.
RESULTS: Rates of hypertension increased from 23.9% (95% confidence interval [CI], 22.7%-25.2%) in 1988-1994 to 28.5% (95% CI, 25.9%-31.3%; P < .001) in 1999-2000, but did not change between 1999-2000 and 2007-2008 (29.0%; 95% CI, 27.6%-30.5%; P = .24). Hypertension control increased from 27.3% (95% CI, 25.6%-29.1%) in 1988-1994 to 50.1% (95% CI, 46.8%-53.5%; P = .006) in 2007-2008, and BP among patients with hypertension decreased from 143.0/80.4 mm Hg (95% CI, 141.9-144.2/79.6-81.1 mm Hg) to 135.2/74.1 mm Hg (95% CI, 134.2-136.2/73.2-75.0 mm Hg; P = .02/P < .001). Blood pressure control improved significantly more in absolute percentages between 1999-2000 and 2007-2008 vs 1988-1994 and 1999-2000 (18.6%; 95% CI, 13.3%-23.9%; vs 4.1%; 95% CI, -0.5% to 8.8%; P < .001). Better BP control reflected improvements in awareness (69.1%; 95% CI, 67.1%-71.1%; vs 80.7%; 95% CI, 78.1%-83.0%; P for trend = .03), treatment (54.0%; 95% CI, 52.0%-56.1%; vs 72.5%; 95% CI, 70.1%-74.8%; P = .004), and proportion of patients who were treated and had controlled hypertension (50.6%; 95% CI, 48.0%-53.2%; vs 69.1%; 95% CI, 65.7%-72.3%; P = .006). Hypertension control improved significantly between 1988-1994 and 2007-2008, across age, race, and sex groups, but was lower among individuals aged 18 to 39 years vs 40 to 59 years (P < .001) and 60 years or older (P < .001), and in Hispanic vs white individuals (P = .004).
CONCLUSIONS: Blood pressure was controlled in an estimated 50.1% of all patients with hypertension in NHANES 2007-2008, with most of the improvement since 1988 occurring after 1999-2000. Hypertension control was significantly lower among younger than middle-aged individuals and older adults, and Hispanic vs white individuals.
Brent M Egan; Yumin Zhao; R Neal Axon
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  JAMA     Volume:  303     ISSN:  1538-3598     ISO Abbreviation:  JAMA     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-05-26     Completed Date:  2010-06-01     Revised Date:  2014-09-17    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2043-50     Citation Subset:  AIM; IM    
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MeSH Terms
Antihypertensive Agents / therapeutic use*
Blood Pressure
Health Knowledge, Attitudes, Practice
Hypertension / drug therapy*,  epidemiology*
Middle Aged
Nutrition Surveys
United States / epidemiology
Grant Support
R0107080684//PHS HHS; R01DK067615/DK/NIDDK NIH HHS; R01NS058728/NS/NINDS NIH HHS
Reg. No./Substance:
0/Antihypertensive Agents
Comment In:
JAMA. 2010 May 26;303(20):2082-3   [PMID:  20501932 ]

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