Trends in Prevalence, Awareness, Management, and Control of Hypertension Among United States Adults, 1999 to 2010

Study Questions:

What are the trends in the prevalence, awareness, management, and control of hypertension in US adults from 1999 to 2010?

Methods:

The authors reported analysis of data from the National Health and Nutrition Examination Survey (NHANES) continuous survey data from 1999 to 2010, using regression models to assess trends in hypertension prevalence, awareness, management, and control. During that time period, there were 28,995 male and female adults in a nationally representative sample of the US population with blood pressure measurement. The authors focused particular attention on the data from the most recent NHANES survey in 2009 to 2010. During this time period, there were 5,764 participants in the nationally representative sample.

Results:

The authors reported that for the survey from 2009-2010, hypertension prevalence was 30.5% among men, and 28.5% among women, among whom there was reported awareness of hypertension of 69.7% (95% confidence interval [CI], 52.0%-77.4%) in men and 80.7% (95% CI, 74.5%-86.8%) in women. Among those subjects with hypertension, the rate of blood pressure controlled was 40.3% (95% CI, 33.7%-46.9%) for men, and 56.3% (95% CI, 49.2%-63.3%) for women. Over the entire period studied, from 1999 to 2010, the prevalence of hypertension remained stable, and rates of hypertension awareness, management, and control remained poor, although with some improvement (74.0% for awareness, 71.6% for managed, 46.5% for control). No improvement was seen from 2007 to 2010 in these parameters.

Conclusions:

The authors concluded that from 1999 to 2010, prevalence of hypertension remains stable. They also concluded that hypertension awareness, management, and control were improved, but remained poor; nevertheless, there has been no improvement since 2007.

Perspective:

These data from the NHANES study are considered among the best estimates of US population health metrics. These extensive surveys employ a rigorous sampling methodology to ascertain a subject population that is representative of the US population. Although these data demonstrate dramatic improvements (rate of control for high blood pressure rose from 27.5% in 1999-2000 up to 46.5% in 2009-2010), they still suggest that a huge gap exists between what our nation has achieved in blood pressure control and our goals. These data suggest that, at the end of the last decade, the United States has achieved target blood pressure control in less than half of the hypertensive population. Exciting and technically sophisticated advances in health care technology over the past two decades have dramatically improved outcomes for patients suffering from cardiovascular events and heart failure. One wonders how much more we could lower the mortality and morbidity of these conditions if more of those resources were applied to adequately addressing hypertension, one of the leading causes of cardiovascular events and heart failure.

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Prevention, Implantable Devices, Acute Heart Failure, Hypertension

Keywords: Prevalence, Morbidity, Cardiac Pacing, Artificial, Heart Failure, Biomedical Technology, Cardiovascular Diseases, Confidence Intervals, Blood Pressure Determination, Hypertension, United States


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