Trends in hypertension prevalence, awareness, treatment, and control in older U.S. adults: data from the National Health and Nutrition Examination Survey 1988 to 2004

OBJECTIVES: To describe hypertension trends in U.S. adults aged 60 and older using National Health and Nutrition Examination Survey (NHANES) data. SETTING: NHANES III (1988-1994) and NHANES 1999 to 2004. DESIGN: Cross-sectional nationally representative health examination survey. PARTICIPANTS: Participants in NHANES III (n=5,093) and NHANES 1999 to 2004 (n=4,710). MEASUREMENTS: Blood pressure (BP). RESULTS: In 1999 to 2004, 67% of U.S. adults aged 60 and older years were hypertensive, an increase of 10% from NHANES III. Between 1988 to 1994 and 1999 to 2004, hypertension control increased for men from 39% to 51% (P<.05) but remained unchanged for women (35% to 37%; P>.05). Non-Hispanic black men and women had higher prevalences of hypertension than non-Hispanic whites (odds ratio (OR)=2.54, 95% confidence interval (CI)=1.90-3.40 and OR=2.07, 95% CI=1.31-3.26, respectively), but men were less likely to have controlled BP (OR=0.60, 95% CI=0.41-0.86). Mexican-American men and women were less likely than non-Hispanic whites to have controlled BP (OR=0.55, 95% CI=0.33-0.91 and OR=0.63, 95% CI=0.40-0.98, respectively). Women and men aged 70 and older were significantly less likely to control their hypertension than those aged 60 to 69. In addition, women aged 70 and older were significantly less aware and treated. Having BP measured within 6 months was significantly associated with greater awareness, greater treatment in men and women, and greater control in women. A history of diabetes mellitus or chronic kidney disease (CKD) was significantly associated with less hypertension control. CONCLUSION: There was a significant increase in hypertension prevalence from 1988 to 2004. Hypertension control continues to be problematic for women, persons aged 70 and older, non-Hispanic blacks and Mexican Americans, and individuals with diabetes mellitus and CKD.     

Ethnic differences in older americans: awareness, knowledge, and beliefs about hypertension

BACKGROUND: Hypertension is often uncontrolled and contributes to health disparities, especially among individuals >or=50 years old. Ethnic differences in awareness, knowledge, and beliefs about hypertension may contribute to these disparities, but information is limited. METHODS: To address this gap, data from a national telephone survey on 1503 Americans 50 years and older were used to assess ethnic differences in awareness, knowledge, and beliefs about hypertension and the relationship of the responses to self-reported blood pressure (BP) control. RESULTS: Overall there were no ethnic differences in knowledge and beliefs about hypertension; however, there were differences in responses to specific questions. African Americans were more knowledgeable about the definition of hypertension and were more aware that hypertension can cause kidney failure than Hispanics and whites (64.2% v 54.8% and 46.3%, P<.0001). African American and Hispanics were more likely to perceive medications as the only way to control BP (50.5% and 55.5% v 23.3%, P<.0001), whereas whites reported lifestyle changes as more important than African Americans in BP control. Comparing self-reported BP control between ethnic groups, belief that medications are not the only way to treat BP (odds ratio [OR] 2.37, 95% confidence interval [CI] 1.43-3.95) and knowledge that moderation of alcohol use can lower BP (OR 2.34, 95% CI 1.20-4.57) were significantly associated with higher BP control rates. CONCLUSIONS: Ethnic differences in specific dimensions of knowledge and beliefs about hypertension exist and account for some of the disparities in BP control. Culturally appropriate educational programs that address these deficiencies may reduce disparities.     

The epidemiology of elevated blood pressure as an estimate for hypertension in Aydin, Turkey.

BACKGROUND: Hypertension is an important public health problem, with some variability of its epidemiological properties in different populations. OBJECTIVES: The purpose of this study was to estimate the prevalence of hypertension and to determine the hypertension awareness, treatment and control rates in Aydin, a Turkish province. METHODS: Of 1600 coincidentally selected people aged over 18 years in Aydin, 1480 (92.5%) had their blood pressure (BP) measured and answered a standard questionnaire in 1995. RESULTS: Estimates of the prevalence of hypertension and its control were computed using two different criteria to define hypertension: BP > or =140/90 mm Hg or on treatment and BP > or =160/95 mm Hg or on treatment. Overall, the estimated prevalence of hypertension was 29.6% (for BP > or =140/90 mm Hg or on treatment). Hypertension prevalence increased progressively with age, from 9% in 18- to 29-year-olds to 70.6% in those 70-79 years of age. Women had a significantly higher prevalence than men (34.1% vs 26.0% respectively). Overall, 57.9% of hypertensive individuals were aware that they had high BP, and 82.1% of aware hypertensives were being treated with antihypertensive medications, but only 19.8% of treated hypertensives were under control (systolic pressure <140 mm Hg and diastolic pressure <90 mm Hg). In addition, housewives, unemployed, and the less educated individuals had greater mean systolic and diastolic BP. CONCLUSIONS: Our results indicate that hypertension is highly prevalent in Aydin, Turkey, and the detection and control of hypertension is unsatisfactory.     

Prevalence,awareness, treatment,and control of hypertension among China’s Sichuan Tibetan population: A cross-sectional study

Background: Our aim is to investigate the prevalence, awareness, treatment, and control status of hypertension and explore the associated factors among Sichuan Tibetan population.Methods: A cross-sectional investigation was conducted in the Sichuan Tibetan region from to September 2013 to March to 2014. Three thousand two hundred and forty persons were included in the study through a multi-stage stratified clustering sampling. Participants received questionnaires and physical examination. Blood pressure (BP) was recorded three times after 5 min of rest with the mean taken as the final BP. Hypertension was defined according the 2010 Chinese guidelines for the management of hypertension.Results: Prevalence of hypertension was 45.7%. The proportion of different stages (1–3) of hypertension was 31.7%, 9.2%, and 7.6% for males and 26.3%, 9.5%, and 6.0% for females. The rate of awareness, treatment, and control of hypertension were 4.9%, 21.3%, and 3.0% for males and 7.5%, 24.5%, and 3.1% for females. Multiple-factor analysis found that age, overweight or obesity (odds ratio(OR)=1.16), drinking alcohol (OR = 1.29, 95% confidence interval (CI):1.07–1.54), increased waist circumference (OR = 1.81, 95%CI: 1.39–2.36), family history of hypertension (OR = 1.51, 95%CI; 1.28–1.78), higher salt intakes (OR = 1.62, 95%CI: 1.24–2.11), long duration of sleep (OR = 1.05, 95%CI: 1.01–1.09), rural area (OR = 1.99, 95%CI: 1.64–2.41), and drinking coffee at times (OR = 0.71, 95%CI:0.57–0.87) were related to hypertension.Conclusion: Prevalence of hypertension in Sichuan Tibetan was significantly higher than the national level with low rates of awareness, treatment, and control of hypertension. Intervention measurements are needed to change some unhealthy lifestyles, behaviors, and habits in this region.     

Facteurs associés à un mauvais contrôle tensionnel chez les patients hypertendus marocains

Study aimHypertension is a major public health concern worldwide and non-controlling it can lead to various cardiovascular complications. Controlling blood pressure and reducing overall cardiovascular risk are two main goals of treatment. Thus, this study aimed to determine the proportion and factors associated with uncontrolled hypertension in hypertensive patients living in the Beni Mellal city.Patients and methodsThe cross-sectional survey took place between June and March 2019. It involved 580 hypertensive patients attending the primary health care facilities in Beni Mellal city, using systematic sampling.ResultsA total of 580 hypertensive patients were recruited, with a mean age of 55.78 (± 10.82 years) and of which 66.89% were female. The proportion of poor blood pressure control was 74.1% and was associated in multivariate analysis with a family history of hypertension(OR = 1.60; 95% CI = [1.02-2.50]), dyslipidemia (OR = 2.05; 95% CI = [1.32 -3.20]), non-adherence to a regular BP measurement (OR = 4.13; 95% CI = [2.49 -6.86]), to treatment (OR = 3.64; 95% CI = [2.34-5.65]) and regular biological monitoring (OR = 2.45; 95% CI = [1.46-4.08]).ConclusionDespite the free and available of treatment, the proportion of uncontrolled hypertension was high. This might be linked to a lack of awareness and education concerning disease self-management.     

Hypertension and antihypertensive treatment in HIV-infected individuals. A longitudinal cohort study

Abstract Objectives. Hypertension is a significant contributor to cardiovascular disease in HIV-infected individuals. The purposes of this study were to assess the development of new-onset hypertension and the use of antihypertensive treatment and blood pressure (BP) control. Methods. In a longitudinal study of 434 HIV-infected individuals (43±11 years, 72% males, follow-up 3.4±0.8 years), standardized BP recordings were undertaken at three clinical visits both at baseline and at follow-up, and cardiovascular risk factors were monitored. Adjusted odds ratio (OR) for new-onset hypertension (systolic BP≥140 and/or diastolic BP≥90 mmHg or initiation of antihypertensive treatment) was calculated using multiple logistic regression analyses. Results. New-onset hypertension occurred with an incidence of 29.8 per 1000 person-years (95% CI 20.3-42.2). HIV duration (OR=1.10, 95% CI 1.01-1.20), mean BP (1.24, 95% CI 1.13-1.35) and abnormal urinary albumin excretion (OR=5.47, 95% CI 1.07-27.85) were independent predictors for new-onset hypertension after adjustment. Use of antihypertensive treatment increased threefold from 17% to 49% in hypertensive patients. Adequate BP control was obtained in 22% of patients on antihypertensive therapy. Conclusions. HIV duration predicted new-onset hypertension, which could suggest involvement of low-grade inflammation; this hypothesis needs to be further explored. Despite increased use of antihypertensive treatment, enhanced awareness and adequate treatment of hypertension are still warranted in HIV-infected individuals.     

Undertreatment of hypertension in community-dwelling older adults: a drug-utilization study in Dicomano, Italy

OBJECTIVE: To define: (1) the prevalence of and (2) factors associated with undertreatment of hypertension in older persons; and (3) the prevalence of specific drug regimens and reasons for their selection. PARTICIPANTS: Cross-sectional survey of persons aged > or =65 years living in Dicomano, Italy. MAIN OUTCOME MEASURES: Prevalence of untreated and uncontrolled hypertension, both defined on the basis of two blood pressure (BP) cut-off points (> or =140/90 and > or =160/90 mm Hg) and of the presence of pharmacological treatment Predictors of undertreatment were analysed for the higher BP cut-off only. RESULTS: Five hundred of 692 (72.3%) and 380/692 (54.9%) participants met the 140/90 and the 160/90 mm Hg BP criterion, respectively. Of the latter, 162 (42.6%) were untreated, 119 (31.3%) had uncontrolled and 99 (26.1%) controlled hypertension. Women [odds ratio (OR), 0.4; 95% confidence interval (CI), 0.2-0.7], participants with coronary artery disease (CAD) (OR, 0.2; 95% CI, 0.1-0.6), stroke (OR, 0.3; 95% CI, 0.1-0.7), and preserved cognitive status (Mini Mental State Examination score >21: 0.3; 95% CI, 0.2-0.7) were more frequently treated. Uncontrolled hypertension was less likely in women (OR, 0.5; 95% CI, 0.3-1.0) and CAD patients (OR, 0.3; 95% CI, 0.1-0.7). Angiotensin converting enzyme (ACE)-inhibitors (55%), calcium (Ca)-antagonists (31%) and diuretics (20%) were the drugs most commonly prescribed. ACE-inhibitors were preferred, and diuretics rarely used, in diabetic subjects. Ca-antagonists were used mostly in CAD participants. CONCLUSIONS: Hypertension is undertreated in the majority of noninstitutionalized older adults, especially in men with impaired cognition and no vascular disease. Drug regimens are mostly based on ACE-inhibitors and Ca-antagonists, as a result of associated clinical conditions, requiring individualized treatment.     

Factors related to poor control of blood pressure with antihypertensive drug therapy

OBJECTIVES: To study the associations of patient-related and perceived healthcare-related factors with the control of blood pressure. SUBJECTS: Physicians identified all of the hypertensive patients they saw during I week in 26 health centres. Out of 2,219 patients, 80% agreed to participate, 88% of which took antihypertensive medication. METHODS: In this cross-sectional questionnaire study, based on 82 opinion statements, 14 problem indices were formed using factor analysis. Logistic regression models were used to study the associations with blood pressure control. RESULTS: Eighty per cent of the men and 79% of the women had poor blood pressure control (BP > or = 140/90 mmHg). High levels of hopelessness towards hypertension (adjusted OR 2.16; 95% confidence interval (CI) 1.20-3.88) as well as medium and high levels of frustration with treatment (adjusted OR 1.50; 95% CI 1.04-2.18 and OR 1.83; 95% CI 0.98-3.44) were associated with poor control. The perceived tension with blood pressure measurement (adjusted OR 1.60; 95% CI 1.08-2.36) was similarly associated with poor control. Non-compliance in men, old age and monotherapy were also associated with poor blood pressure control. CONCLUSION: Hopelessness, frustration with treatment, and perceived tension with blood pressure measurement are associated with poor blood pressure control.     

Insulin resistance, body mass index, waist circumference are independent risk factor for high blood pressure

OBJECTIVES: The purpose of the present study was to investigate the relationships between blood pressure (BP), insulin resistance as determined by a homeostasis model (HOMA-IR), and body fat distribution. METHODS: Anthropometric indices of adiposity, metabolic variables (fasting serum insulin and a homeostasis model assessment [HOMA] index of insulin sensitivity), BP and several cardiovascular risk factors were measured during a cross sectional survey of 53477 apparently healthy Korean subjects who requested a health status check. Hypertension was defined as a systolic BP > or = 140 mmHg or a diastolic BP > or = 90 mmHg and we excluded the subjects taking BP-lowering medication. RESULTS: Systolic and diastolic blood pressure (SBP, DBP) were positively and significantly associated with age, body mass index, waist circumference, and waist/hip ratio. In addition, SBP and DBP were positively associated with fasting serum insulin levels and the HOMA index. By multiple regression analysis age, waist circumference, body mass index, HOMA index and female sex were independently associated with either increased SBP or DBP. When the population is divided into quintiles according to insulin resistance (measured by HOMA analysis) prevalence of hypertension in the second, third, fourth and fifth quintiles compared to subjects in the first quintile are 1.004(95% CI 0.875-1.152, p = 0.957), 1.200(95% CI 1.052-1.369, p = 0.007), 1.312(95% CI 1.151-1.494 p < 0.001 ), and 1.603(95% CI 1.408-1.825 p < 0.001). In addition age, sex, body mass index and waist circumference were found to be significantly associated with hypertension. CONCLUSION: Our results showed that insulin resistance, body mass index and waist circumference are independent risk factors of a high BP in Koreans.     

Evaluating potentially modifiable risk factors for prevalent and incident nocturia in older adults

OBJECTIVES: To examine associations between nocturia and potentially modifiable risk factors in older adults. DESIGN: Secondary analysis of cross-sectional and longitudinal data. SETTING: Respondents were selected using population-based sampling, drawing from a single Michigan county in 1983. They were followed through 1990. PARTICIPANTS: Community-living adults aged 60 and older. MEASUREMENTS: Episodes of nocturia, development of nocturia at 2 years after baseline survey, age, sex, hypertension, diabetes mellitus, drinking fluids before bedtime, amount of fluid intake before bedtime, diuretic use, and 24-hour coffee intake. All measures were self-reported. RESULTS: Bivariate cross-sectional analysis revealed significant associations with two or more episodes of nocturia for hypertension (odds ratio (OR)=1.7, 95% confidence interval (CI)=1.37-2.1), diabetes mellitus (OR=1.51, 95% CI=1.1-2.0), diuretic use (OR=1.7, 95% CI=1.3-2.1), age (OR=1.05 per additional year over 60, 95% 1.03-1.06), and number of cups of coffee (OR=0.93 for each cup of coffee, 95% CI=0.89-0.97). In multivariate analysis, hypertension (OR=1.52, 95% CI=1.2-1.9), diuretic use (OR=1.3, 95% 95% CI=1.0-1.7), and age (OR=1.04 per additional year over 60, 95% 1.03-1.06) were independently associated with two or more nocturia episodes per night. No baseline factors predicted future development of nocturia (save for age, in one model). CONCLUSION: Hypertension, older age, and diuretic use were independently associated with two or more episodes of nocturia in cross-sectional analysis. No baseline factor was related to the development of nocturia over a 2-year interval in this sample. Nighttime fluid intake and coffee intake, practices providers commonly target in patients with nocturia, were not associated with nocturia in this population-based sample of community-living older adults.     

Relationship between social network and hypertension in older people in Spain

INTRODUCTION AND OBJECTIVES: To investigate the association between a patient's social network and hypertension risk in older adults in Spain and to determine whether the nature of the social network is related to a patient's awareness of hypertension, to disease treatment and control, or to adherence to hypertension drug therapy. PATIENTS AND METHOD: Cross-sectional study of 3483 subjects representative of the non-institutionalized Spanish population aged 60 years or more. Logistic regression analysis, adjusted for sex, age, educational level, lifestyle and frequency of medical consultation, was used to derive odds ratios (ORs) for associations between characteristics of the social network (e.g., marital status, cohabitation status, frequency of contact with family members, and frequency of contact with friends and neighbors) and aspects of hypertension. RESULTS: The hypertension risk in married individuals and those living with others was less than in those who were unmarried (OR=0.79; 95% confidence interval [CI] 0.67-0.94) or who lived alone (OR=0,75; 95% CI, 0.61-0.93). Men who saw their friends frequently were more likely to be aware of hypertension (OR=1.57; 95% CI, 1.19-2.07). Women who saw their friends or neighbors frequently were less likely to be aware (OR=0.70; 95% CI, 0.51-0.97). No clear relationship between social network characteristics and other hypertension-related variables was observed. CONCLUSIONS: In older adults, hypertension was associated with aspects of social integration, such as marital and cohabitation status. Among hypertensives, awareness of hypertension was partly related to the frequency of contact with family and friends or neighbors.     

Prevalence and correlates of fear of falling, and associated avoidance of activity in the general population of community-living older people

BACKGROUND: Little is known about the prevalence rates and correlates of fear of falling and avoidance of activity due to fear of falling in the general population of community-living older people. OBJECTIVE: To assess prevalence rates and study correlates of fear of falling and avoidance of activity due to fear of falling in this population. Study design and setting: cross-sectional study in 4,031 community-living people aged > or =70 years. RESULTS: Fear of falling was reported by 54.3% and associated avoidance of activity by 379% of our population. Variables independently associated with fear of falling were: higher age (> or =80 years: odds ratio (OR) =1.79; 95% confidence interval (CI) =1.49-2.16), female gender (OR = 3.23; 95% CI = 2.76-3.79), poor perceived general health (OR = 6.93; 95% CI = 4.70-10.21) and multiple falls (OR = 5.72; 95% CI = 4.40-7.43). Higher age (> or =80 years: OR = 1.92; 95% CI = 1.59-2.32), poor perceived general health (OR = 11.91; 95% CI = 8.38-16.95) and multiple falls (OR = 4.64; 95% CI = 3.73-5.76) were also independently associated with avoidance of activity. CONCLUSIONS: Fear of falling and avoidance of activities due to fear of falling, were highly prevalent in our sample of community-living older people. Particularly, poor perceived general health showed a strong, independent association with both, fear of falling, and related avoidance of activity. Findings of our study may help health care professionals to identify people eligible for interventions aimed at reducing fear of falling and activity restriction.     

Are demographic characteristics, health care access and utilization, and comorbid conditions associated with hypertension among US adults?

BACKGROUND: Little is known about the factors associated with hypertension awareness, treatment, and control. We examined the association of demographic and socioeconomic characteristics, risk factors, health care access and utilization, and hypertension awareness, treatment, and control. METHODS: The National Health and Nutrition Examination Survey (NHANES) 1999-2004, a continuous, annual survey of the civilian non-institutionalized US population. The sample comprised 4,816 hypertensive persons aged 20+ years. RESULTS: Adults > or =60 years were more likely to have uncontrolled hypertension compared with adults 40-59 years old (60-69 years old: odds ratio (OR) 1.69, confidence interval (CI) 1.31-2.17; 80+ years old: OR 3.56, CI 2.42-5.25, respectively). Compared to men, women were more likely to have uncontrolled hypertension (OR 1.29, CI 1.01-1.64). When compared with non-Hispanic whites, non-Hispanic blacks were more likely to have uncontrolled hypertension (OR 1.40, CI 1.10-1.79). Diabetes and Poverty Income Ratio (PIR) classification of <1 were associated with increased likelihood of uncontrolled hypertension (OR 2.69, CI 1.99-3.63; OR 1.68, CI 1.19-2.37; respectively). Persons without health insurance had higher odds of being untreated when compared with insured persons (OR 2.38, CI 1.71-3.32). Younger age (20-39 years), lack of risk factors for hypertension and less health care were associated with increased odds of being unaware of hypertension. CONCLUSIONS: Uncontrolled hypertension is more likely among women, older persons (> or =60 years), non-Hispanic blacks, the poor, and diabetics. Hypertension awareness and treatment is lower among the young (20-39 years), the uninsured, individuals reporting fewer health risk factors, and adults with less exposure and utilization of health care.     

Blood pressure control and improved cardiovascular outcomes in the International Verapamil SR-Trandolapril Study

Uncontrolled blood pressure (BP) increases cardiovascular risk, independent of type of treatment. In this posthoc International Verapamil SR-Trandolapril Study analysis, we determined whether adverse outcomes are related to consistency of BP control, defined as the proportion of visits in which BP was in control. A total of 22 576 patients with hypertension and coronary artery disease were divided into 4 groups according to the proportion of visits in which BP was in control (<140/90 mm Hg): <25%, 25% to <50%, 50% to <75%, and >or=75%. Risk of primary outcome (first occurrence of death, nonfatal myocardial infarction, or nonfatal stroke), myocardial infarction, and stroke decreased progressively from the group with <25% to the group with >or=75% of visits with BP control. Adjusted risks of primary outcome (heart rate: 0.60; 95% CI: 0.53 to 0.67), myocardial infarction (heart rate: 0.58; 95% CI: 0.48 to 0.70), and stroke (heart rate: 0.50; 95% CI: 0.37 to 0.67) were less in the group with >or=75% of visits with BP control compared with the group with <25% of visits with BP control. Baseline BP was not predictive of outcomes. Proportion of visits with BP control was associated with mean follow-up systolic BP (r(2)=0.64), both being independently related to primary outcome. As proportion of visits with BP control increases, there is an associated steep reduction in cardiovascular risk, independent of baseline characteristics and mean on-treatment BP. Consistency of BP control during treatment provides additional information on the protective effect of antihypertensive treatment. Physicians need to be concerned at each visit if BP is not controlled.     

Associations of microalbuminuria and blood pressure with carotid, aortic and femoral atheromatous plaques in elderly Finns

AIMS: To evaluate the possible associations of microalbuminuria (MA) and blood pressure (BP) with the ultrasonographic manifestations of carotid, aortic and femoral atherosclerosis in 65-year-old Finns. METHODS: Ultrasonographic measurements were performed on 54 diabetic subjects, 97 subjects with impaired glucose tolerance (IGT) and 57 normoglycemic subjects (NGT). Urinary albumin and creatinine concentrations were measured from an early morning spot urine sample, and the urinary albumin-to-creatinine ratio (ACR) of > or = 2.5 mg/mmol in men and > or = 3.5 mg/mmol in women was used as a measure of MA. Hypertension was defined as either a systolic BP of > or = 160 mmHg or a diastolic BP of > or = 95 mmHg or being on antihypertensive medication. RESULTS: Eighteen subjects were microalbuminuric and 176 subjects normoalbuminuric. MA was associated with diabetes mellitus and high systolic and diastolic BP. The subjects were divided into two groups according to the median total number of carotid, aortic and femoral plaques: > or = 9 versus 0-8 plaques. A high number of plaques were associated with hypertension, male gender, smoking and MA. When the study subjects were stratified according to hypertension, it turned out that MA was associated with a high number of plaques in hypertensive, but not in nonhypertensive subjects. According to the results of logistic regression analysis with a high number of plaques as the dependent variable, the unadjusted OR for smoking was 6.0 (95% CI 2.4-15.3) in hypertensive subjects. Microalbuminuria was of borderline statistical significance (OR 4.5, 95% CI 0.9-22.9). After adjustment for systolic blood pressure and fasting glucose concentration, the OR for microalbuminuria was reduced to 3.3 (95% CI 0.6-18.4).     

Type 2 diabetes is associated with left ventricular concentric remodeling in hypertensive patients

BACKGROUND: Left ventricular (LV) geometric remodeling is associated with cardiovascular prognosis in hypertensive patients. It is uncertain how LV remodeling is modulated by diabetes in hypertensive patients. In this study, we investigated the impact of diabetes and ambulatory blood pressure (BP) on LV geometric remodeling in hyptensives with/without diabetes. METHODS: Ambulatory BP monitoring and echocardiography were performed to compare 24-h BP levels and LV measurements in 400 uncomplicated hypertensives (mean age, 67 years, 152 men and 248 women) between diabetic (n = 161) and nondiabetic (n = 239) patients. RESULTS: The age (67 v 68 years), percentage of men (43% v 34%), body mass index (24.5 v 24.0 kg/m(2)), 24-h systolic BP (144/80 v 144/82 mm Hg), LV mass index (128 v 130 g/m(2)) were similar between the groups. Diabetic patients had higher relative wall thickness (0.50 v 0.44, P < .001) and higher prevalence of concentric LV hypertrophy (39.4% v 26.8%, P < .001) than nondiabetic patients. The presence of diabetes (odds ratio [OR] = 2.76; 95% confidence interval [CI] = 1.73-4.41, P < .001) and 24-h systolic BP (OR for 10 mm Hg increase = 1.17; 95% CI = 1.01-1.37, P < .05) were independently associated with the higher relative wall thickness (>/=0.45). On the other hand, 24-h systolic BP was independently associated with LV hypertrophy (OR for 10 mm Hg increase = 1.32; 95% CI = 1.14-1.52, P < .05). CONCLUSIONS: Among hypertensive patients, type 2 diabetes was associated with concentric LV geometry independent of ambulatory BP.     

Isolated systolic hypertension--epidemiology and impact in clinical practice.

OBJECTIVE: To study the frequency, distribution and determinants of isolated systolic hypertension (ISH). DESIGN: Cross-sectional study, in two stages. First, consecutive patients of the Portuguese national health system aged 60 or over were selected (1999). The second stage covered people aged up to 60 years (2000). SETTING: Health Centers--primary care (Regional Health Administration--Lisbon). PARTICIPANTS: 3228 patients, 1100 male (439 aged up to 60 years and 661 aged > or = 60 years) and 2128 female (860 aged up to 60 years and 1268 aged > or = 60 years). MEASUREMENTS: Categories of hypertension. Risk stratification. Cardiovascular morbidity. Predictors of isolated systolic hypertension. RESULTS: The definition and staging of hypertension changed between 1988 and 1997/99 and as a consequence, there has been, in hypertensives, an increase in ISH frequency from 13% to 44% (2.4 times greater). This form of hypertension is far more frequent than grades 1 (mild hypertension = 22%), 2 (moderate hypertension = 15%) or 3 (severe hypertension = 7%). The proportion of hypertensives with ISH increases from 19% in people aged up to 40, to 30% in the fourth decade, 34% in the fifth decade, 44% in the sixth decade, 51% in the seventh decade, and 57% in those over 80 years of age. In hypertensives aged up to 50, ISH is more frequent in females. However, in those over age 50 it is predominant in males. ISH represents 60% and 37% respectively of untreated and treated hypertensives. Among untreated hypertensives, age was associated with ISH (p < 0.001; OR = 1.051 and 95% CI 1.037-1.065). In the over-60 subgroup, the following factors were associated: age (p = 0.013; OR = 1.048 and 95% CI 1.010-1.087); gender--male (p = 0.004; OR = 2.578 and 95% CI 1.361-4.881) and height (p = 0.044; OR = 0.966 and 95% CI 0.933-0.999). CONCLUSIONS: Isolated systolic hypertension is the most common form of hypertension and the most often untreated. The constitutional characteristics associated with isolated systolic hypertension in the elderly are age, gender (male) and body mass index (height). The extent of the problem justifies more attention to control of systolic blood pressure, both in research (efficacy) and in clinical practice (effectiveness).     

Factors associated with lack of awareness and uncontrolled high blood pressure among Canadian adults with hypertension

Background

Approximately 17% of Canadians with high blood pressure were unaware of their condition, and of Canadians aware of having the condition, approximately 1 in 5 have uncontrolled high blood pressure despite high rates of pharmacotherapy. The objectives of the current study are to estimate the prevalence of resistant hypertension and examine factors associated with (1) lack of awareness and (2) uncontrolled hypertension despite pharmacotherapy.

Methods

Using the 2007-2009 Canadian Health Measures Survey (N = 3473, aged 20-79 years) and logistic regression, we quantified relationships between characteristics and (1) presence of hypertension, (2) lack of awareness (among those with hypertension), and (3) uncontrolled high blood pressure (among those treated for hypertension).

Results

Older age, lowest income, and less than high school education were associated with presence of hypertension. Men (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.1-2.2) and adults < 60 years (OR, 1.7; 95% CI, 1.1-2.6) were more likely than others to be unaware. Among those aged 60+ years, women were more likely than men to have uncontrolled high blood pressure (OR, 2.4; 95% CI, 1.1-5.2) despite treatment. Elevated systolic blood pressure was the issue in over 90% of women and 80% of men with uncontrolled hypertension. Depending on the definition employed, 4.4% (95% CI, 2.4-6.4) to 7.8% (95% CI, 6.0-9.6) of the population with hypertension had resistant hypertension.

Conclusions

Messaging or interventions encouraging screening may be helpful for all younger Canadian adults and men; programs encouraging blood pressure control may help older women.     

Blood pressure levels and hypertension status among ethnic groups in England

The prevalence of cardiovascular disease and hypertension show wide variability among different ethnic groups in the UK. We combined data collected annually between 1991-1996 in the Health Surveys for England--nationwide surveys that provide information on the health status in a representative sample of the population living in England, to compare blood pressure (BP) levels, hypertension rates (systolic BP > or = 160 mm Hg or diastolic BP > or = 95 mm Hg, or those on antihypertensive medication), hypertension treatment and control rates in people of white, black (combining black-Caribbean, black-African and black-other), and South Asian origin (combining Indians, Pakistanis and Bangladeshis). Analyses were stratified into two age groups, 16-39 (younger) and > or = 40 years (older), but were focused on older adults (30,619 whites, 295 blacks and 529 South Asians). Age-adjusted mean BP levels and hypertension rates of older adults were highest among blacks, while South Asian men showed BP levels and hypertension rates similar to black men and South Asian women had mean BP levels and hypertension rates similar to white women. After controlling for age, BMI, smoking, alcohol consumption, and social class the odds ratio (OR) of being hypertensive among older adults was higher in black men (OR 2.0; 95% CI 1.4, 2.9; P < 0.001); black women (OR 1.7; 95% CI 1.2, 2.5; P < 0.01); and South Asian men (1.9; CI 1.4, 2.4; P < 0.001), than in their white counterparts. Among those studied with hypertension, treatment rates were highest among black men and women. Among those on antihypertensive medication, the odds of having BP controlled (SBP < 160 mm Hg and DBP < 95 mm Hg) did not differ among the three groups of older men but was reduced in older South Asian women, compared with white women.