Control Of Hypertension In Population Research Articles

Association between population hypertension control and ischemic heart disease and stroke mortality in 36 countries of the Americas, 1990-2019: an ecological studyAssociação entre controle populacional da hipertensão e mortalidade por doença cardíaca isquêmica e acidente vascular cerebral em 36 países das Américas, 1990-2019: um estudo ecológico

To quantify the association between the prevalence of population hypertension control and ischemic heart disease (IHD) and stroke mortality in 36 countries of the Americas from 1990 to 2019. This ecologic study uses the prevalence of hypertension, awareness, treatment, and control from the NCD-RisC and IHD and stroke mortality from the Global Burden of Disease Study 2019. Regression analysis was used to assess time trends and the association between population hypertension control and mortality. Between 1990 and 2019, age-standardized death rates due to IHD and stroke declined annually by 2.2% (95% confidence intervals: -2.4 to -2.1) and 1.8% (-1.9 to -1.6), respectively. The annual reduction rate in IHD and stroke mortality deaccelerated to -1% (-1.2 to -0.8) during 2000-2019. From 1990 to 2019, the prevalence of hypertension controlled to a systolic/diastolic blood pressure ≤140/90 mmHg increased by 3.2% (3.1 to 3.2) annually. Population hypertension control showed an inverse association with IHD and stroke mortality, respectively, regionwide and in all but 3 out of 36 countries. Regionwide, for every 1% increase in population hypertension control, our data predicted a reduction of 2.9% (-2.94 to -2.85) in IHD deaths per 100 000 population, equivalent to an averted 25 639 deaths (2.5 deaths per 100 000 population) and 2.37% (-2.41 to -2.33) in stroke deaths per 100 000 population, equivalent to an averted 9 650 deaths (1 death per 100 000 population). There is a strong ecological negative association between IHD and stroke mortality and population hypertension control. Countries with the best performance in hypertension control showed better progress in reducing CVD mortality. Prediction models have implications for hypertension management in most populations in the Region of the Americas and other parts of the world.

Association between population hypertension control and ischemic heart disease and stroke mortality in 36 countries of the Americas, 1990-2019: an ecological study.

ABSTRACTObjective.To quantify the association between the prevalence of population hypertension control and ischemic heart disease (IHD) and stroke mortality in 36 countries of the Americas from 1990 to 2019.Methods.This ecologic study uses the prevalence of hypertension, awareness, treatment, and control from the NCD-RisC and IHD and stroke mortality from the Global Burden of Disease Study 2019. Regression analysis was used to assess time trends and the association between population hypertension control and mortality.Results.Between 1990 and 2019, age-standardized death rates due to IHD and stroke declined annually by 2.2% (95% confidence intervals: –2.4 to –2.1) and 1.8% (–1.9 to –1.6), respectively. The annual reduction rate in IHD and stroke mortality deaccelerated to –1% (–1.2 to –0.8) during 2000-2019. From 1990 to 2019, the prevalence of hypertension controlled to a systolic/diastolic blood pressure ≤140/90 mmHg increased by 3.2% (3.1 to 3.2) annually. Population hypertension control showed an inverse association with IHD and stroke mortality, respectively, regionwide and in all but 3 out of 36 countries. Regionwide, for every 1% increase in population hypertension control, our data predicted a reduction of 2.9% (–2.94 to –2.85) in IHD deaths per 100 000 population, equivalent to an averted 25 639 deaths (2.5 deaths per 100 000 population) and 2.37% (–2.41 to –2.33) in stroke deaths per 100 000 population, equivalent to an averted 9 650 deaths (1 death per 100 000 population).Conclusion.There is a strong ecological negative association between IHD and stroke mortality and population hypertension control. Countries with the best performance in hypertension control showed better progress in reducing CVD mortality. Prediction models have implications for hypertension management in most populations in the Region of the Americas and other parts of the world.

Hypertension prevalence, awareness, treatment and control in Ghanaian population: Evidence from the Ghana demographic and health survey.

Hypertension is a major cause of cardiovascular disease morbidity and mortality in Ghana. This study examines the prevalence, awareness, treatment and control of hypertension among Ghanaian aged 15–49 years. This cross-sectional study retrieved data from the 2014 Ghana Demographic and Health Survey (GDHS). The sample, comprising of 13,247 respondents aged 15–49 years, was analysed using descriptive statistics, Chi-Square tests, independent sample t-tests and binary logistic regressions. The overall prevalence of hypertension was 13.0% (12.1% for males and 13.4% for females). Among respondents who had hypertension, 45.6% were aware of their hypertension status; 40.5% were treating the condition while 23.8% had their blood pressure controlled (BP <140/90 mmHg). Socio-economic and demographic factors, health insurance coverage and recent visit to health facilities played significant roles in hypertension prevalence and awareness. While region of residence and health facility visits were predictors of hypertension treatment, age and region of residence predicted hypertension control in this population. This study suggests that in order to address the increasing burden of hypertension in Ghana, there should be an expansion of the National Health Insurance Scheme and development of measures to reduce health inequities. Also, some of the determining factors such as age, gender, marital status are similar to other cultures; therefore, existing interventions from those cultures could be adapted in addressing hypertension prevalence, awareness, treatment and control in Ghana.

\u201cThey\u2019re younger\u2026 it\u2019s harder.\u201d Primary providers\u2019 perspectives on hypertension management in young adults: a multicenter qualitative study

BackgroundYoung adults (18–39 year-olds) have the lowest hypertension control rates among adults with hypertension in the United States. Unique barriers to hypertension management in young adults with primary care access compared to older adults have not been evaluated. Understanding these differences will inform the development of hypertension interventions tailored to young adults. The goals of this multicenter study were to explore primary care providers’ perspectives on barriers to diagnosing, treating, and controlling hypertension among young adults with regular primary care.MethodsPrimary care providers (physicians and advanced practice providers) actively managing young adults with uncontrolled hypertension were recruited by the Wisconsin Research & Education Network (WREN), a statewide practice-based research network. Semi-structured qualitative interviews were conducted in three diverse Midwestern clinical practices (academic, rural, and urban clinics) using a semi-structured interview guide, and content analysis was performed.ResultsPrimary care providers identified unique barriers across standard hypertension healthcare delivery practices for young adults. Altered self-identity, greater blood pressure variability, and unintended consequences of medication initiation were critical hypertension control barriers among young adults. Gender differences among young adults were also noted as barriers to hypertension follow-up and antihypertensive medication initiation.ConclusionsTailored interventions addressing the unique barriers of young adults are needed to improve population hypertension control. Augmenting traditional clinic structure to support the “health identity” of young adults and self-management skills are promising next steps to improve hypertension healthcare delivery.

Association between Primary Care Quality and Health Behaviors in Patients with Essential Hypertension Who Visit a Family Physician as a Usual Source of Care

Background: Management of hypertension has been performed mainly in primary care institutions, but hypertension control in population is still unsatisfactory. This study was aimed at finding a strategy to improve health promotion activities in patients with hypertension by exploring the association between health behaviors and quality of primary care. Methods: April to June in 2007, a questionnaire survey of the patients who has a family physician as a usual source of care was conducted for the development of the Korean Primary Care Assessment Tool (KPCAT). In this study, a usual source of care was defined as a physician of the persons who had visited their primary care clinic on six or more occasions over a period of more than 6 months. Of the data collected from 9 private clinics (3 in Seoul and 6 at small cities), cases of the patients who marked on having hypertension were selected. The associations between levels of quality of primary care and socio-demographic characteristics or health behaviors were analysed by Student t-test and chi-square test. Controlling socio-demographic variables, the association between quality of primary care and health behaviors was examined by multiple logistic regression analysis. Results: Among the patients (n = 602) of 9 private clinics who has a family physician as a usual source of care, those who marked on having hypertension were 134. Among 5 domains of the KPCAT, the highest domain in score was personalized care (71.7/100), and the lowest domain in score was coordination function (49.7/100). In patients who gave total average (69.2/100) or more in total primary care score, after adjustment with age, sex, income, education, and duration, odds ratio to have a normal BMI (<25 kg/m) was 2.53 (P = 0.02), and odds ratio to have a habit drinking an adequate amount of alcohol was 4.32 (P = 0.02). Conclusion: The fact that high-quality primary care was associated with good health behaviors in this study suggests that improving quality of primary care by health care reform can make health behaviors more desirable in patients with essential hypertension.

Practical aspects of treatment discontinuation and adherence

Hypertension control in populations, although improving, remains far from satisfactory, even though effective and inexpensive therapies are available. Among many factors responsible for this situation, poor adherence to treatment appears to be particularly important. Unfortunately, even if its causes have been quite well defined, this problem is still far from being solved in clinical practice. The present paper discusses the key issues related to treatment adherence, and discontinuation in hypertension, in the light of recent evidence coming from the ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET) and Telmisartan Randomized AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease trial (TRANSCEND).

2005 IASH Lifetime Achievement Award

HomeHypertensionVol. 46, No. 42005 IASH Lifetime Achievement Award Free AccessNewsPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessNewsPDF/EPUB2005 IASH Lifetime Achievement Award Originally published1 Oct 2005https://doi.org/10.1161/01.HYP.0000184885.26020.d1Hypertension. 2005;46:923Artur B. Ribeiro, MD, is a Brazilian nephrologist whose research has advanced understanding and treatment of high blood pressure. A graduate of the Federal University of São Paulo, Escola Paulista de Medicina, in 1969, Dr Ribeiro pursued postgraduate training in nephrology and hypertension at Cornell University Medical Center, Nephrology Division, and Mount Sinai School of Medicine, Hypertension Division in New York, between 1973 and 1976. At his postgraduate training, Dr Ribeiro joined Dr Haralambos Gavras and Dr Lawrence Krakoff, pioneers in hypertension research, and, under their mentorship, initiated a program of research on the role of the renin-angiotensin system in experimental and clinical hypertension.On his return to Brazil in 1976, Dr Ribeiro became professor at the Federal University of São Paulo, Escola Paulista de Medicina, Nephrology Division, where he is the Chief of the Hypertension Section and served as Past President of the Oswaldo Ramos Foundation, Kidney and Hypertension Hospital. He developed an extensive research program in experimental and clinical hypertension and mentored many physicians who have become medical leaders and university professors in different regions of Brazil.Dr Ribeiro’s research encompasses multiple areas of hypertension on both experimental and clinical aspects, including the role of the renin-angiotensin and kallikrein-kinin systems, the role vasopressin V-1 receptor, and renal damage in hypertension and diabetes, as well as his recent studies on the glucose metabolism disturbances in hypertension. He has also participated as an investigator in many Clinical Trials in Hypertension, and was a member of the steering committee of the Renal Clinical Trial. Dr Ribeiro has published more than 125 papers and 2 books.Dr Ribeiro served as Past President of the Inter-American Society of Hypertension, Past President of the Brazilian Society for Clinical Investigation, delegate at the World Health Organization for Hypertension Control in Population, member of the Scientific Council of the International Society of Hypertension and Guideline Subcommittee of the WHO-ISH Guideline for Management of Hypertension (1993 and 1999 Guidelines), and Visiting Professor of Medicine at Boston University School of Medicine, Hypertension and Atherosclerosis Section (1991–1992). He also acted as chair of the 9th Scientific Meeting of the Inter-American Society in 1991 and 20th Scientific Meeting of the International Society of Hypertension in 2004 and as a member of the editorial boards of Hypertension, Journal of Hypertension, European Journal of Medicine and International Trends in Hypertension.Dr Ribeiro is a Fellow of the Council for High Blood Pressure Research, American Heart Association; member of the Executive Council of the American Society of Hypertension, the Scientific Council of the Brazilian Society of Hypertension, and Brazilian Academies of Science and Medicine; and Vice-President of the Brazilian Society of Hypertension.Dr Ribeiro has received several awards for his research presented in national and international scientific meetings, and he has spoken at several conferences on hypertension throughout Latin America, Europe, Asia, Africa, and North America. Download figureDownload PowerPoint Previous Back to top Next FiguresReferencesRelatedDetails October 2005Vol 46, Issue 4 Advertisement Article InformationMetrics https://doi.org/10.1161/01.HYP.0000184885.26020.d1PMID: 16200667 Originally publishedOctober 1, 2005 PDF download Advertisement

Strategies for improvement of awareness, treatment and control of hypertension: results of a panel discussion.

High blood pressure (BP) is a major risk factor for coronary heart disease, heart failure, stroke, chronic kidney disease, end stage renal disease, and a variety of other clinically important outcomes. Results from the surveys described in this issue and elsewhere underscore a common finding that hypertension is both highly prevalent and insufficiently treated and controlled. Recognizing the differences in sampling and survey measurement techniques, the reported prevalence of hypertension (SBP/DBP >/=140/90 mmHg or treatment with antihypertensive medication) in adults exceeded 25% in all of the surveys reported in this issue. In Latvia, the prevalence of hypertension for 25-64-year-old adults in the general population was 46.1%. Control of hypertension with medication to an SBP/DBP <140/90 mmHg in the general population ranged from as low as 12% to a high of only 29%. Data from other parts of the world provide an equally distressing picture of what is (not) being accomplished in treatment and control of hypertension at the level of the general population. These data provide testimony to an urgent need for greater attention to the treatment and control of hypertension in populations around the world. This was the basis for a panel discussion at the International Society of Hypertension satellite conference The Epidemiology of Hypertension-Regional Differences in Treatment and Control. Panel participants included Drs P Whelton, S Sonkodi, DG Beevers, JG Fodor, H Elliot, R Cifkova, A Nissinen, A Javor, and there was active participation of other symposium attendees. The following summarizes key elements of the discussion and recommendations of the panel.

Self-reported hypertension treatment practices among primary care physicians: blood pressure thresholds, drug choices, and the role of guidelines and evidence-based medicine.

Primary care physician treatment practices affect the rate of hypertension control to the goal of 140/90 mm Hg. Awareness of and agreement with national hypertension management guidelines, and grounding in evidence-based medicine principles, may be important determinants of practice. A 26-item mail questionnaire was sent to a national sample of 1200 primary care physicians. The questionnaire elicited (1) the blood pressure (BP) criteria physicians use to initiate and intensify hypertension treatment, (2) first-line drug treatment choices, (3) familiarity with the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC) hypertension treatment guidelines, and (4) familiarity with research methods used to develop evidence-based medicine guidelines. The analysis focused on (1) determining the percentage of physicians who reported treatment practices consistent with JNC recommendations and (2) the relation between familiarity with JNC guidelines, evidence-based medicine methods, and reported treatment practices. The overall response rate was 34%, with no important differences in demographic or professional training variables between respondents and nonrespondents. For middle-aged patients with uncomplicated hypertension, 33% of physicians would not start drug therapy unless the diastolic BP was greater than 95 mm Hg, and 43% would not start unless the systolic BP was greater than 160 mm Hg. In patients without complications who were receiving drug treatment, 25% of physicians would not intensify therapy for a persistent diastolic BP of 94 mm Hg, and 33% would not intensify therapy for a systolic BP of 158 mm Hg. Physicians were generally less aggressive in older patients. Angiotensin-converting enzyme inhibitors were the most common first-line drug choice. Forty-one percent of physicians had not heard of or were not familiar with the JNC guidelines. In multiple logistic regression models, familiarity with the JNC guidelines was associated with lower treatment thresholds, and increased familiarity with research methods was associated with greater use of diuretics or beta-blockers as first-line agents. Many physicians have higher BP thresholds for the diagnosis and treatment of hypertension than the 140/90 mm Hg criterion recommended by the JNC. Therefore, further improvements in population hypertension control will require physician behavior change. Physician practice is associated with awareness of practice guidelines and familiarity with evidence-based medicine methods, but the precise nature and extent of this relation requires further study.

Detection and Control of Hypertension in the Population: The United States Experience

Trends in prevalence, awareness, treatment, and control of hypertension in the adult US population are reported. The data are from the National Health and Nutrition Examination Surveys (NHANES), carried out in four separate surveys, the last being NHANES III, 1988–1991. The age-adjusted prevalence of hypertension at ≥ 160/95 mm Hg declined from 20% to 14%, and at > 140/90 mm Hg it declined from 36.3% to 20.4% in NHANES III. Hypertension awareness increased significantly to as high as 89% for those with blood pressures ≥ 160/95 mm Hg. For all people with blood pressure ≥ 160/95 mm Hg, nearly 64% have it controlled below that level, but only 29% have their blood pressure controlled below 140/90 mm Hg. Although the data from these surveys are encouraging, there are still too many people in the United States with uncontrolled hypertension.

The treatment of hypertension.

1. A 'retrospective' of the development of the drug treatment of hypertension is presented from the early days of ganglion blockers to the present time together with a review of the evidence of benefit from treatment. 2. Current issues and debates are summarised including shortfalls in the control of hypertension in populations, difficulties surrounding the measurement of blood pressure, disagreement on the levels of blood pressure to treat, the goal blood pressures to aim at, issues surrounding lifestyle measures such as the low salt diet and low intensity exercise, and treatment with diuretics and with calcium antagonists. 3. A 'perspective' is presented on some avenues for progress in the years ahead. These will include the identification of genetic markers to determine the hypertensive individuals with the greatest risk of death and of cardiovascular complications.

Control of hypertension in the population. Strategies in affluent and developing countries.

Control of hypertension in population. Strategies in affluent and developing countries. The control of hypertension encompasses primary prevention, early detection and adequate treatment of high blood pressure. Primary prevention involves action at the population level to reduce obesity, alcohol and salt consumption, and to increase physical activity. The management of hypertension involves diagnostic work-up, assessment of overall cardiovascular disease risk, non-pharmacological and pharmacological treatment. The majority of community control programmes emphasized detection and treatment, rather than primary prevention. There are limitations to pharmacological treatment of hypertension, as shown by various studies, where a significant proportion of hypertensives have not been controlled by the treatment applied. In addition, the blood pressure-cardiovascular risk relationship is continuous and progressive and, even within the conventionally defined "normotensive" range, complications occur with escape control. Developing countries will encounter the problem of prohibitive costs of care and drug treatment for hypertension. Therefore greater emphasis must be put on primary prevention in population control of hypertension.

Policies for the Control of Hypertension in Populations—Joint Symposium of the Inter-American Society of Hypertension and the World Hypertension League

(1995). Policies for the Control of Hypertension in Populations—Joint Symposium of the Inter-American Society of Hypertension and the World Hypertension League. Clinical and Experimental Hypertension: Vol. 17, No. 7, pp. 1075-1077.

The World Hypertension League: goals and perspectives.

The World Hypertension League (WHL) is a federation of currently 51 national and regional organizations, committed to the prevention of hypertension. The objectives of the WHL are to promote the prevention, detection, and control of hypertension in populations by liaising with the member organizations, promoting the exchange of information among them, and offering internationally applicable methods and programs for hypertension control. This article describes objectives and policies, as well as projects and ongoing activities of the WHL

The epidemiology of hypertension control in populations.

Despite an aging population, prevalence rates for hypertension in the U.S. remain stable due to a decrease in rates in women but a corresponding increase in rates for men. Epidemiological factors which may contribute to these rates are discussed. The lack of a threshold for the association between blood pressure and disease events means that the majority of events occur in the larger number of people with mild disease. Because the efficacy and cost-effectiveness of medical therapy to lower mildly elevated blood pressure remains controversial, population-based strategies to effect behavior change are the most prudent course for this, the largest group at risk. Targeted, resource-intensive medical intervention for those at high risk combined with hygienic measures for the population with mildly elevated blood pressure from the basis for an effective public health strategy.

Impediments to the control of hypertension. Hypertension Management Audit Group.

Despite the great therapeutic advances, the control of hypertension in populations is far below the achievable level, even in populations with highly developed health care. By the end of the 1980's, in selected European centres, 18-34% of cases of hypertension were undetected, and among those previously known, 22-38% were untreated. The cooperative WHO/WHL Hypertension Management Audit Project aimed at assessing some of the impediments to better control of hypertension. The concepts and attitudes of 2,215 physicians were surveyed. In various centres and at various patient ages, 25-45% of physicians would not start drug treatment below 100 mm Hg. When inquiring into the perceived reasons why hypertension had not been detected earlier, among other reasons, physicians tended to incriminate their workload, while patients often felt that there was a lack of interest on the doctor's part to take a blood pressure reading. In general, patient satisfaction seemed suboptimal. Physician's sources of information were varied; neither WHO, nor ISH or WHL seemed to play an important role in informing the physicians.