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Closing the Gap in Hypertension Control Between Younger and Older Adults: National Health and Nutrition Examination Survey (NHANES) 1988 to 2010
Study Questions:
What are time-dependent changes in hypertension control to <140/<90 mm Hg in younger adults (ages <60 years), and to both <140/<90 mm Hg and <150/<90 mm Hg in older adults (ages ≥60 years)?
Methods:
This was a cross-sectional analysis of data from the National Health and Nutrition Examination Survey (NHANES). Data from 1998 to 1994, 1999 to 2004, and 2005 to 2010 were analyzed. The main outcome was hypertension control, defined as <140/<90 mm Hg for younger adults. Hypertension control at the evidence-based goal of <150/<90 mm Hg was also assessed in older adults.
Results:
From 1998 to 1994 to 2005 to 2010, hypertension control to <140/<90 mm Hg improved in both older (31.6% to 53.1%; p < 0.001) and younger (45.7% to 55.9%; p < 0.001) adults. Control to <150/<90 mm Hg improved from 48.8% to 69.9% in older adults. For younger adults, the following variables were independently related to blood pressure control to <140/<90 mm Hg: age, ≥2 versus <2 health care visits annually, with versus without health insurance, statin therapy versus no statin therapy, and with versus without clinical cardiovascular disease. In older adults, hypertension control improved with increasing body mass index (converse to that observed in younger adults), ≥2 health care visits annually, and statin therapy versus no statin therapy.
Conclusions:
From 1998 to 1994 to 2005 to 2010, there have been improvements in hypertension control in both younger and older adults, and the age gap in hypertension control has narrowed significantly. Furthermore, more frequent health care visits and statin therapy are independent predictors of hypertension control in both older and younger adults.
Perspective:
This is an important study that establishes improvements in hypertension control in both younger and older adults over the past two decades. The age gap in control has narrowed, and, for an evidence-based goal of <150/<90 mm Hg, control in older adults exceeds that of younger adults (for <140/<90 mm Hg). Nearly 70% of all older adults in NHANES achieved the goal of <150/<90 mm Hg. While these findings spark optimism and are encouraging, there remains room for much improvement. Nearly one-half of younger adults did not achieve hypertension control. The limitations of this analysis side, more frequent health care visits appear to be associated with improved control. The association between statin prescription and better blood pressure control, while plausible, warrants further study.
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