Hypertension in the United States 1999–2012: Progress Toward Healthy People 2020 Goals

Study Questions:

What is the current prevalence, rates of treatment, and controlled hypertension in the United States?

Methods:

To reduce the cardiovascular disease burden, Healthy People 2020 established US hypertension goals for adults to: decrease prevalence to 26.9%, and to raise treatment to 69.5% and control to 61.2%, which requires controlling 88.1% on treatment. The National Health and Nutrition Examination Surveys (NHANES) assess health and nutritional status of the US civilian noninstitutionalized population. Participants are selected using a multistage, probability sampling design. All adults provided written consent approved by the National Center for Health Statistics. Participants included adults ≥18 years old in NHANES 1999–2012, with at least one recorded blood pressure (BP). To assess current status and progress toward these Healthy People 2020 goals, time trends in NHANES 1999–2012 data in 2-year blocks were assessed in adults ≥18 years old, age-adjusted to US 2010.

Results:

From 1999–2000 to 2011–2012, prevalent hypertension was unchanged (30.1% vs. 30.8%, p = 0.32). Hypertension treatment (59.8% vs. 74.7%, p < 0.001) and proportion of treated adults controlled (53.3% to 68.9%, p = 0.0015) increased. Hypertension control to <140/<90 mm Hg rose every 2 years from 1999–2000 to 2009–2010 (32.2% vs. 53.8%, p < 0.001) before declining to 51.2% in 2011–2012. Modifiable factor(s) significant in multivariable logistic regression modeling included: (a) increasing body mass index with prevalent hypertension (odds ratio [OR], 1.44); (b) lack of health insurance (OR, 1.68) and <2 health care visits/year (OR, 4.24) with untreated hypertension; and (c) health care insurance (OR, 1.69), ≥2 health care visits/year (OR, 3.23), and cholesterol treatment (OR, 1.90) with controlled hypertension.

Conclusions:

The authors concluded that data from NHANES suggest improved management of obesity (prevention and treatment), improved health care coverage (better insurance and two or more health care visits per year), and improved cholesterol treatment would likely result in improved hypertension.

Perspective:

Efforts at prevention including efforts initiated for children, adolescents, and young adults in addition to older ages are needed to improve rates of prevention of elevated blood pressure.

Clinical Topics: Dyslipidemia, Prevention, Lipid Metabolism, Nonstatins, Hypertension

Keywords: Cholesterol, National Center for Health Statistics (U.S.), Body Mass Index, Blood Pressure, Obesity, Nutritional Status, Insurance, Health, Nutrition Surveys, Cost of Illness, Hypertension, United States


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