Racial/ethnic disparities in prevalence, treatment, and control of hypertension--United States, 1999-2002

High blood pressure (HBP) is a major risk factor for heart disease and stroke, end-stage renal disease, and peripheral vascular disease and is a chief contributor to adult disability. Approximately one in four adults in the United States has hypertension. Although effective therapy has been available for more than 50 years, most persons with hypertension do not have their blood pressure (BP) under control. National health objectives for 2010 include reducing the proportion of adults with HBP to 16% (baseline: 28%), increasing the proportion of adults with hypertension who are taking action to control it to 95% (baseline: 82%), and increasing the proportion of adults with controlled BP to 50% (baseline: 18%). During 1990-2000, the prevalence of hypertension, the percentage of those with hypertension who were aware of their condition, and treatment and control of hypertension increased among non-Hispanic whites, non-Hispanic blacks, and Hispanics. CDC analyzed data from the National Health and Nutrition Examination Surveys (NHANES) for 1999-2002. This report summarizes the results of that analysis, which determined that racial/ethnic disparities in awareness of, treatment for, and control of hypertension persist. If national health objectives are to be met, public health efforts must continue to focus on the prevention of HBP and must improve awareness, treatment, and control of hypertension among minority populations.     

State-specific trends in self-reported blood pressure screening and high blood pressure--United States, 1991-1999

High blood pressure (HBP) increases the risk for heart disease and stroke, the first and third leading causes of death in the United States, respectively. An estimated one in four U.S. adults has HBP, which is defined as taking antihypertensive medication or having either a systolic blood pressure (SBP) of > or = 140 mmHg or a diastolic blood pressure (DBP) of > or = 90 mmHg. Optimal blood pressure is defined as SBP of < or = 120 mmHg or DBP of < or = 80 mmHg. To reduce the prevalence of HBP in the United States, the National Heart, Lung, and Blood Institute initiated the National High Blood Pressure Education Program (NHBPEP) in 1972, recommending that all adults aged > or = 20 years have their blood pressure (BP) checked at least once every 2 years. Although HBP is easily detectable and can usually be controlled with treatment, greater awareness of BP levels among U.S. adults is needed. This report summarizes data from the Behavioral Risk Factor Surveillance System (BRFSS) on state-specific trends in recent BP screening and prevalence of HBP (both by self-report). The findings indicate that during 1991-1999, BP screening levels were very high, and the percent of adults reporting HBP increased among some populations. Innovative education and intervention programs are needed to prevent and treat HBP in five high-risk groups: men, blacks, Hispanics, persons with less education, and older adults.     

Prevalence of overweight and obesity among adults with diagnosed diabetes--United States, 1988-1994 and 1999-2002

Obesity in persons with diabetes is associated with poorer control of blood glucose levels, blood pressure, and cholesterol, placing persons with diabetes at higher risk for both cardiovascular and microvascular disease. Conversely, intentional weight loss is associated with reduced mortality among overweight persons with diabetes. CDC analyzed the prevalence of overweight and obesity among U.S. adults aged >/=20 years with previously diagnosed diabetes by using data from two surveys: the Third National Health and Nutrition Examination Survey (NHANES III), 1988-1994, and NHANES 1999-2002. This report summarizes the results of that analysis, which indicated that most adults with diagnosed diabetes were overweight or obese. During 1999-2002, the prevalence of overweight or obesity was 85.2%, and the prevalence of obesity was 54.8%. Encouraging patients to achieve and maintain a healthy weight should be a priority for all diabetes-care programs.     

高血压前期人群高血压预防的探讨

目的探讨高血压前期人群高血压的预防。方法97例BP120～139／80～89mmHg高血压前期的居民被管理一年,列为试验组。92例BP131～139／85～89mmHg高血压前期的居民未被管理,列为对照组。853例原发性高血压也被列为对照。结果97例管理后BP120～139／80～89mmHg高血压前期人群的收缩压、舒缩压和体重指数分别较管理前和92例未被管理的高血压前期的居民低（均P〈0．05）。血压120—139／80～89mmHg的人群的收缩压、舒张压、性别分别与原发性高血压之间具有非常显著意义的差别（均P〈0．005）。结论对高血压前期人群进行管理对预防原发性高血压疗效明显。     

低钠富钾替代盐对农村社区人群血压影响的现场观察

目的 评价市售低钠富钾替代盐对农村社区居民血压的影响效果。方法采用流行病学类实验设计,在山东省莱芜市2个农村社区,经过血压筛查,将411名30～ 60岁的研究对象分为高血压组和非高血压组,两组均以家庭为单位给予3个月的低钠富钾替代盐替换普通食盐进行干预,定期观察血压及其24 h尿钠的变化。结果用低钠富钾替代盐干预1个月时高血压组和非高血压组人群血压开始呈下降趋势,3个月后评估时高血压组收缩压(SBP)平均下降7.4 mm Hg(1 mm Hg=0.133 kPa;t= 10.096,P=0.000),舒张压(DBP)下降3.8 mm Hg(t=8.017,P=0.000);非高血压组SBP平均下降1.2 mm Hg(t=2.507,P= 0.007),DBP下降1.0 mm Hg(t=2.987,P=0.002)。干预3个月后评估时高血压组24 h尿钠平均下降15.5 mmol(t= 1.803,P=0.037),尿钾上升4.2 mmol(t’=2.132,P=0.018),钠钾比下降1.2(t=2.786,P=0.003);非高血压组24 h尿钠平均下降1.7 mmol(t =0.211,P=0.417),尿钾上升3.7 mmol(t’=2.207,P=0.015),钠钾比值下降0.7(t= 1.818,P=0.036)。结论低钠富钾替代盐能有效降低人群血压水平,且人群依从性较好,是一种有效的非药物预防控制高血压方法。     

中国成年人高血压患病率、知晓率、治疗和控制状况

目的　评估中国成年人高血压的患病率、高血压知晓率、治疗和控制状况。方法　亚洲国际心血管病合作研究 (InterASIA)于 2 0 0 0～ 2 0 0 1年进行 ,应用多阶段抽样方法选择有代表性的样本。共调查了 35～ 74岁的成年人 15 838人。测量血压时 ,先让调查对象休息 5min ,由经过培训合格的调查人员应用标准水银柱血压计测量 3次血压。应用标准问卷询问高血压病史及高血压的治疗情况。高血压定义为收缩压≥ 140mmHg、舒张压≥ 90mmHg或正在服用降压药。结果　 35～ 74岁的中国成年人的高血压患病率为 2 7 2 %,即全国约有 1 3亿高血压患者。 35～ 44、45～ 5 4、5 5～ 6 4和 6 5～ 74岁年龄组的高血压患病专率分别为男性 17 4%、 2 8 2 %、 40 7%和 47 3 %;女性为 10 7%、2 6 8%、38 9%和 5 0 2 %。在高血压病人中 ,44 7%知道自己患有高血压 ,2 8 2 %正在服用降压药 ,8 1%的人血压得到了控制 ( <140 / 90mmHg)。在过去 10年中 ,高血压知晓、治疗和控制率的增长百分率分别为 86 2 %、92 6 %和 145 4%。结论　在过去的 10年中 ,高血压知晓、治疗和控制率有显著的提高。中国成年人高血压的患病率比较高 ,而高血压的知晓率偏低 ,治疗率和控制率又非常低。在我国迫切需要改善高血压的预防、检测和治疗状况     

National Health and Nutrition Examination Survey 1999-2000: effect of observer training and protocol standardization on reducing blood pressure measurement error

OBJECTIVE: We describe the National Health and Nutrition Examination Survey (NHANES) blood pressure (BP) observer training and protocol standardization and evaluate the quality of BP measurement. METHODS: The participants were persons aged 8 years and older who had their BP measured (n=7467) during NHANES 1999-2000. Cuff width/arm circumference ratio (CW/AC), end digit preference, and observer agreement were examined. RESULTS: In stepwise principal components multiple regression analysis, CW/AC accounted for less than 2% of variability R(2) in all readings. The frequencies for all end digits were close to 20% ("0" end digit=21% systolic and 23% diastolic). No overall observer effect was present for mean systolic BP readings. A significant observer effect (P<.0001) was detected for mean diastolic BP readings of <90 mm Hg. For readings of > or =90 mm Hg, there was no significant observer effect (P=.157). CONCLUSION: We conclude that NHANES BP measurements do not demonstrate the variability that is commonly caused by observer and technical error.     

我国成年人单纯性收缩期高血压患病率调查

目的评估我国成年人单纯性收缩期高血压的患病率及其人群分布。方法亚洲国际心血管病合作研究(InterASIA)于2000至2001年进行,应用多阶段抽样方法选择15540名35～74岁成年人为代表性样本,分析单纯性收缩期高血压和其他亚型高血压的患病率。应用标准问卷调查高血压病史及其治疗情况。血压值为休息5min后3次坐位血压测量值的平均值。未接受抗高血压治疗的个体通过以下标准确定高血压亚型单纯性收缩期高血压为收缩压≥140mmHg(1mmHg=0133kPa),舒张期血压<90mmHg;单纯性舒张期高血压为收缩压<140mmHg,舒张压≥90mmHg,而收缩期和舒张期联合性高血压为收缩压≥140mmHg,舒张压≥90mmHg。结果15540名35～74岁成年人样本中,76%(1181人)患有单纯性收缩期高血压,74%(1150人)患有收缩期和舒张期联合性高血压,而44%(683人)患有单纯性舒张期高血压。收缩期高血压的患病率随着年龄的增长而增加,且老年女性比老年男性更为常见。南方与北方地区的单纯性收缩期高血压患病率没有明显差异;农村单纯性收缩期高血压患病率高于城市。结论我国收缩期高血压患病率较高,应引起重视。     

Need to prevent and control high-normal and high blood pressure, particularly so-called "mild" hypertension: epidemiological and clinical data

The need to prevent and control high blood pressure (HBP), including so-called "mild" hypertension [diastolic blood pressure (DBP) 90-104 mm Hg in adults age 30+] stems from the extensive data on the increased risks due to these common blood pressure (BP) levels, including risk of catastrophic cardiovascular events (coronary, cerebrovascular, etc.), both nonfatal and fatal. Prospective population data from the national cooperative Pooling Project and the Chicago Heart Association Detection Project in Industry illustrate the extensively documented facts. They also show that only a small minority of middle-aged and older Americans have optimal low-normal BP levels, i.e., DBP less than 80 mm Hg (SBP less than 120). Thus, the problem of BP above optimal level for health over a long life span is a population-wide problem. The data also show that the great majority of excess catastrophic events attributable to elevated BP occur among people with DBP 90-104 and 80-89 mm Hg, levels very common in the population. Most people with such BP levels also have one or more other major risk factors (e.g., hypercholesterolemia, cigarette use, ECG abnormalities) and thus are at markedly increased risk, both relative and absolute. In addition to these excess risks for major illness, disability, and death, people with BP above optimal levels are more highly prone to other events, clinical and subclinical, that have adverse effects on long-term prognosis, including development of target organ damage and severe hypertension. These data lead to the following inferences about medical care and public health strategy: (a) A key task is, by safe nutritional-hygienic means, to shift the entire population distribution of BP downward, for both primary and secondary prevention of HBP. Such means include prevention and control of obesity, high sodium and alcohol intake, and sedentary habit, from early childhood on. (b) People with DBP 80-89 mm Hg need to be identified promptly, with institution of nutritional-hygienic measures to prevent development of frank hypertension and to correct other risk factors. (c) People with DBP 90-104 and higher need to be identified promptly, with institution of measures to normalize BP and control other major risk factors, by nutritional-hygienic means alone whenever possible or in combination with drug treatment for HBP when necessary to prevent organ system damage, serious illness, disability, and premature death.(ABSTRACT TRUNCATED AT 400 WORDS)     

广州市15～69岁常住居民高血压患病率、知晓率、治疗率及控制率调查

目的了解广州市15～69岁常住居民的高血压患病率、知晓率、治疗率和控制率情况,为高血压的综合防治工作提供依据。方法采用多阶段抽样的方法,抽取7026名广州市常住居民进行问卷调查和血压测量。结果高血压患病率为15.1%,标化率为18.0%,知晓率为31.6%,药物治疗率为28.8%(包括只按医嘱服药者16.9%和综合治疗者11.9%),非药物治疗率为1.2%,高血压控制率为12.6%。结论广州市成人高血压患病率近年有增加的趋势,而知晓率、治疗率及控制率偏低,尤其是在农村地区,需要进一步加强高血压知识的宣传教育,提倡综合治疗及社区的系统管理工作,做到早诊断、早治疗、早控制。     

The treatment of adults with essential hypertension

Hypertension is arbitrarily defined as diastolic blood pressure (DBP) of 90 mm Hg or higher, systolic blood pressure (SBP) of 140 mm Hg or higher, or both, on 3 separate occasions. Essential hypertension is hypertension without an identifiable cause. Essential hypertension, also known as primary or idiopathic hypertension, accounts for at least 95% of all cases of hypertension. According to the third National Health and Nutrition Examination Survey (NHANES III), approximately 60% of the 50 million Americans with hypertension are at increased risk for cardiovascular disease resulting from uncontrolled hypertension. This is because only 53% of hypertensive patients are being treated and only 24% have their hypertension under control. Physicians must play an active role in identifying and treating hypertension. In an earlier Applied Evidence article, an approach to the diagnosis of hypertension was presented. This article reviews the treatment of essential hypertension in adults and the prognosis of untreated hypertension. Risk stratification, alternative therapies, lifestyle modification, drug therapy, and prognosis will each be reviewed sequentially.     

Knowledge,Beliefs, and Behaviors about Hypertension Control Among Middle-Aged Korean Americans with Hypertension

This report describes the management and control of high blood pressure (HBP) in a sample of middle-aged (40 to 64 years) Korean Americans (KAs) with HBP. Participants in the Self-Help Intervention Program for HBP care (SHIP-HBP), a culturally tailored clinical trial for HBP management in KAs through lifestyle approaches, underwent baseline assessments to determine HBP control status and knowledge, beliefs, and practices related to HPB control. Data were stratified by sex. In all, 445 Korean patients are described. About 55% of the sample were receiving antihypertensive therapy, and less than one-third had controlled BP (< 140/90 mm Hg). Sex differences were observed in terms of clinical characteristics and anti-hypertensive medication use: women were more likely than men to have controlled BP and lower diastolic BP and to have been on HBP medication. Lower rates of smoking, drinking, and overweight or obesity were also observed more frequently in women. Most participants agreed that taking anti-hypertensive medication lowered BP. When asked what the most important behavioral factor was for controlling BP, about a quarter reported cutting down on salt, followed by exercise and medication taking. While poor HBP control remains a common problem that contributes to significant cardiovascular morbidity and mortality, particularly among ethnic minorities, our findings underscore the need to test the beneficial effects of primary and secondary prevention programs, suitably modified to meet the language, cultural, and individual needs of this high-risk population of hypertensive patients.     

Knowledge,treatment and control of hypertension. Results of a multicenter study of patients hospitalized for cardiac ischemia

The study objective was to assess the prevalence, level of treatment, and control of hypertension in CHDs patients. We conducted a cross-sectional survey on 1109 patients hospitalised for a first episode of MI in the main hospitals of the District of Tunis during the period 1999-2000. Hypertension and control level are defined according to the JNC recommendations. HBP is defined as SBP > = 140 and or DBP > = 90 mm Hg and the use of blood pressure-lowering medication for the indication of hypertension. Hypertension is controlled by medication if SBP < 140 and DBP < 90 mm Hg. We conduct analysis by socio demographic variables, medical history and CHDs risk factors. 54.9% men and 72.1% women were hypertensive. The prevalence of hypertension increases with age in both genders. The logistic regression have shown that the age-adjusted odds ratios were statically significant for diabetes, obesity, high cholestrolemia and cigarettes smoking. Only 68.9% of the hypertensive were aware of having hypertension, women were more aware than men (84.6% versus 61.7%, p < 0.001). Awareness increase with age and education level. Among hypertensive, 94.4% were treated but only 41.3% were controlled. The study highlights the problem of the hypertension, and contributes to identify the iceberg of this CHDs risk factor. An effort must be done to involve the health personnel for educating patients, the population for changing their life style and manager for enhancing the availability of drugs. The question is how much will be the cost of HBP and CVDs control for a country which has a limited resources.     

Hypertension in the nursing home

Hypertension in a nursing home patient is a systolic blood pressure of 140 mm Hg or higher and 130 mm Hg or higher in a patient with diabetes mellitus or chronic renal insufficiency, or a diastolic blood pressure of 90 mm Hg or higher and 80 mm Hg or higher in a patient with diabetes mellitus or chronic renal insufficiency. Numerous prospective, double-blind, randomized, placebo-controlled studies have demonstrated that antihypertensive drug therapy reduces the development of new coronary events, stroke, and congestive heart failure in older persons. The goal of treatment of hypertension in elderly persons is to lower the blood pressure to less than 140/90 mm Hg and to less than 130/80 mm Hg in older persons with diabetes mellitus or chronic renal insufficiency. Elderly persons with diastolic hypertension should have their diastolic blood pressure reduced to 80 to 85 mm Hg. Diuretics should be used as initial drugs in the treatment of older persons with hypertension and no associated medical conditions. The selection of antihypertensive drug therapy in persons with associated medical conditions depends on their associated medical conditions. If the blood pressure is more than 20/10 mm Hg above the goal blood pressure, drug therapy should be initiated with 2 antihypertensive drugs, one of which should be a thiazide-type diuretic. Other coronary risk factors must be treated in patients with hypertension.     

Prevalence, treatment, and control of diagnosed diabetes in the U.S. National Health and Nutrition Examination Survey 1999-2004

PURPOSE: This study aimed to examine the trends in prevalence, treatment, and control of diagnosed diabetes in United States adults 20 years of age or older. METHODS: Data from the National Health and Nutrition Examination Survey 1999-2004 were used. Glycemic, blood pressure, and total cholesterol target levels were defined as having glycosylated hemoglobin <7.0%, blood pressure <130/80 mm Hg, and total cholesterol <200 mg/dL, respectively. RESULTS: The prevalence of diagnosed diabetes was 7.8% in 2003-2004 and increased significantly in people aged 40-59 years, women, non-Hispanic whites, and obese people in the period 1999-2004. Although there was no significant change in the pattern of antidiabetic treatment, the age-adjusted percentage of people with diagnosed diabetes achieving glycemic and blood pressure target levels increased from 35.8% to 57.1% (p = 0.002) and from 35.7% to 48.3% (p = 0.04), respectively. However, there were only insignificant increases in percentages of those persons achieving total cholesterol target level (from 48.8% to 50.4%) and those achieving all 3 target levels (from 7.5% to 13.2%). CONCLUSIONS: In 1999-2004, the prevalence of diagnosed diabetes increased significantly in some subgroups of the population. However, the increases in percentages of people with diabetes achieving glycemic and blood pressure targets are encouraging, although there is room for improvement.     

上海市成年居民高血压流行特点及防治现状

目的了解上海市居民高血压的流行现状。方法于2007年10月—2008年1月采用多阶段分层随机抽样的方法,对上海市17174名15～69岁常住人群进行问卷调查和血压测量。结果调查人群平均收缩压和舒张压分别为(129.3±17.1)mmHg和(81.3±9.5)mmHg,并均随年龄增加而升高(P0.001)。其中高血压患者4056人,高血压患病率为23.62%,标化患病率14.50%。中心城区高于非中心城区(P=0.001)。上海居民的高血压知晓率、治疗率和控制率分别为85.5%,74.2%和31.5%,中心城区高于非中心城区,女性高于男性,差别均有统计学意义(P0.01)。结论上海市居民平均血压较高,高血压知晓率和治疗率较高,但治疗率还有待进一步提高。     

The prevalence, awareness and control of hypertension in Laval, Quebec, 1986

The prevalence, awareness and control of hypertension were assessed in a representative sample (n = 1,374) of the Laval population (aged 30-69 years). The study was designed to identify people at increased risk for cardiovascular disease because of elevated blood pressure levels rather than to establish a strict clinical prevalence. Defining hypertension as systolic pressure greater than or equal to 140 mm Hg and/or diastolic pressure greater than or equal to 90 mm Hg and/or on anti-hypertensive medication, the study found a prevalence of 25% (32% in men, 19% in women). Two thirds (67%) of the male hypertensives and 41% of the female hypertensives were previously unaware of their condition. One in three hypertensives were on medication, and less than half of these were under control. As observed in other studies, control was better in women. The study suggests the continuing need for high blood pressure education and detection in the Laval population, particularly among men.     

Disparities in screening for and awareness of high blood cholesterol--United States, 1999-2002

High blood cholesterol is a major modifiable risk factor for atherosclerotic cardiovascular disease. Two national health objectives for 2010 are to reduce to 17% the proportion of adults with high total blood cholesterol levels and to increase to 80% the proportion of adults who had their blood cholesterol checked during the preceding 5 years. In addition, an overall national health objective is to eliminate racial/ethnic and other disparities in all health outcomes. During 1960-1994, total blood cholesterol levels among the overall U.S. population declined; however, levels have changed little since then, despite increases in cholesterol screening and awareness. To assess racial/ethnic and other disparities among persons who were screened for high blood cholesterol during the preceding 5 years and among persons who were aware of their high blood cholesterol, CDC analyzed data from the 1999-2000 and 2001-2002 National Health and Nutrition Examination Surveys (NHANES). This report summarizes the results of that analysis, which indicated that Mexican Americans, blacks, and younger adults were less likely to be screened for high blood cholesterol, and persons in those populations who had high cholesterol were less likely to be aware of their condition. Efforts are needed to encourage persons, especially among these populations, to seek screening and gain awareness of high blood cholesterol.     

Financial cost as an obstacle to hypertension therapy.

A home health interview, including blood pressure measurements, was conducted on 4,688 adults representing the noninstitutionalized population of Georgia. Subjects with diastolic blood pressure greater than or equal to 90 mm Hg or on antihypertensive medication were considered hypertensive. The prevalence of uncontrolled moderate or severe hypertension (diastolic greater than or equal to 105 mm Hg) was 1.9 per cent. With the exception of White women, all race-sex groups with uncontrolled moderate or severe hypertension reported substantially lower per capita income than their mild or controlled hypertensive counterparts. A larger percentage of the uncontrolled moderate to severe hypertensives on medication, as compared to their mild or controlled counterparts, reported economic barriers to pharmacologic and medical care on cost of medicines (36 per cent vs 22 per cent); refills (36 per cent vs 16 per cent); and office visits (26 per cent vs 16 per cent). Black women reported these barriers more than Whites. These findings suggest that costs of antihypertensive care may be an obstacle in blood pressure control for certain population subgroups.     

Elevated blood pressure among U.S. adults with diabetes, 1988-1994.

BACKGROUND: Recent guidelines and clinical trial results emphasize the importance of controlling blood pressure among people with diabetes. We estimated the prevalence of elevated blood pressure among U.S. adults with diagnosed diabetes, and examined the extent to which elevated blood pressure is being treated and controlled. METHODS: The Third National Health and Nutrition Examination Survey (1988-1994), a probability survey of the civilian, non-institutionalized population of the United States, consisted of an interview and physical examination, which included blood pressure measurement. Survey participants included 1507 adults (aged > or = 18 years) with self-reported diabetes. Among people with self-reported diabetes, we estimated elevated blood pressure (mean blood pressure of > or = 130/85 mm Hg or use of antihypertensive medication); awareness (prior diagnosis of hypertension); treatment (antihypertensive medication use); and control (mean blood pressure of <130/85 or <140/90). RESULTS: In the 1988-1994 period, 71% (95% confidence interval [CI]=+/-4.4%) of all U.S. adults with diabetes had elevated blood pressure. The prevalence of elevated blood pressure increased with age and was high among both men and women and among Mexican Americans, non-Hispanic blacks, and non-Hispanic whites. Among those with elevated blood pressure, 71% (95% CI=+/-4.1%) were aware and 57% (95% CI=+/-4.2%) were treated, but only 12% (95% CI=+/-3.2%) had mean blood pressure <130/85 and 45% (95% CI=+/-4.9%) had mean blood pressure <140/90. Control of blood pressure was least common among older people. CONCLUSIONS: All people with diabetes-regardless of age, gender, and race and ethnicity-may benefit from efforts to prevent hypertension. The control of elevated blood pressure is inadequate and broad-based efforts are needed to improve blood pressure control.