Prevalence Of Uncontrolled Hypertension Research Articles

Risk factors of uncontrolled hypertension in hypertensive patients in the Tunisian population

Uncontrolled hypertension is associated with an increased risk of cardiovascular complications. Determining the factors of poor blood pressure control helps to set up more effective therapeutic strategies. The objective of our study was to identify factors associated with uncontrolled hypertension confirmed by ambulatory blood pressure monitoring (ABPM) in our population. We conducted a retrospective case-control study including patients who had an ABPM between January 2014 and June 2017. The diagnosis of uncontrolled hypertension was defined as a mean 24-hour BP ≥ 130/80 mmHg. We divided our patients into 2 groups: G1: patients with uncontrolled hypertension and G2: patients with controlled hypertension. The comparison between the 2 groups was carried out by chi 2 tests for univariate analysis and logistic regression for multivariate analysis. A total of 175 hypertensive patients were included, sex-ratio M/F = 0.9. The indication of ABPM was an uncontrolled hypertension in office in 143 cases (82%) and blood pressure control in 32 cases (18%). The prevalence of uncontrolled hypertension was 51%. The 24-hour BP was 151/87 mmHg in the G1 and 123/69 mmHg and G2 group ( P < 0.001). In univariate analysis, factors associated with poorly controlled hypertension were: male gender ( P = 0.002), smoking ( P = 0.018), personal history of chronic renal failure ( P = 0.027), presence of metabolic syndrome ( P = 0.008) and hyper glycaemia ( P = 0.01). In multivariate analysis, uncontrolled hypertension was associated with male gender ( P = 0.05), presence of metabolic syndrome ( P = 0.044), and low HDL cholesterol level ( P = 0.05). In our population, more than half of hypertensive patients were not adequately controlled. The main determinants of this poor control were: male gender and metabolic syndrome. Adequate care, by monitoring these factors, is essential for a better blood pressure control.

Uncontrolled hypertension and associated factors among adult hypertensive patients in Ayder comprehensive specialized hospital, Tigray, Ethiopia, 2018

BackgroundDespite the availability and improvement in diagnostic and therapeutic interventions with proven benefits in reducing cardiovascular morbidity and mortality, control rates of hypertension remain poor and grossly inadequate. Around one billion individuals are living with uncontrolled hypertension globally. Uncontrolled hypertension among hypertensive patients on treatment in Ethiopia ranges from 11.4 to 69.9%. Therefore, the aim of this study was to determine the magnitude and associated factors of uncontrolled hypertension among hypertensive patients in Ayder comprehensive specialized hospital, Tigray, Ethiopia 2018.Methods and materialsHospital-based cross-sectional study design was conducted from February 16–April 30/2018. Simple random sampling method was used to select 320 participants. Data was collected using interviewer administered standard structured questionnaire. Self-care practice measuring tool was adopted from hypertension self-care activity level effects (H-scale). Data was entered to and cleaned by Epi Info version 7 and it was exported to SPSS version 22 for analysis. Binary logistic regression model (AOR, 95% CI and p-value < 0.05) was used to determine the predictors of uncontrolled hypertension.ResultFrom the total respondents, 164 (51.2%) were females. The mean age of the respondents was 53.83 + 14.52 years. Prevalence of uncontrolled hypertension was found 52.5%. Overweight (AOR = 4.527, 95% CI: 2.247–9.123), co-morbidity (AOR = 2.112, 95% CI: 1.218–3.662), non-adherence to anti-hypertensive medication (AOR = 2.062, 95% CI: 1.030–4.129), non-adherence to physical activity (AOR = 1.931, 95% CI: 1.074–3.470) and non-adherence to alcohol abstinence (AOR = 2.093, 95% CI: 1.109–3.948) are independent predictors of uncontrolled hypertension.Conclusionthe prevalence of uncontrolled hypertension is high. Patients’ adherence to antihypertensive medication, physical exercise and alcohol abstinence should be maximized. Weight reduction and early identification and management of co-morbidities are also crucial.

Sex-specific responses to mineralocorticoid receptor antagonism in hypertensive African American males and females

BackgroundAfrican Americans (AA) develop hypertension (HTN) at an earlier age, have a greater frequency and severity of HTN, and greater prevalence of uncontrolled HTN as compared to the white population. Mineralocorticoid antagonists have been shown to be very effective in treating uncontrolled HTN in both AA and white patients, but sex-specific responses are unclear.MethodsWe evaluated the sex-specific impact of mineralocorticoid antagonism in an AA population. An AA cohort (n = 1483) from the Genetic Epidemiology Network of Arteriopathy study was stratified based on sex and whether they were taking spironolactone, a mineralocorticoid antagonist, in their antihypertensive regimen.ResultsAs compared to AA women not prescribed a mineralocorticoid antagonist, AA women taking spironolactone (n = 9) had lower systolic and diastolic blood pressure despite having a similar number of antihypertensive medications. The proportion of AA women with uncontrolled HTN was significantly less for patients taking spironolactone than for patients not prescribed spironolactone. Interestingly, none of these associations were found in the AA males or in white females.ConclusionsOur data suggests that spironolactone is particularly effective in reducing blood pressure and controlling HTN in AA women. Further research into the impact of this therapy in this underserved and understudied minority is warranted.

Uncontrolled Hypertension among Treated Hypertensive Patients

Objectives: To determine the prevalence of uncontrolled hypertension among Yemeni hypertensive patients on treatment. Methods: Cross sectional study was conducted among hypertensive adult patients presented to a private cardiac center in Sana’a from January to December 2016. All adult patients diagnosed to have hypertension for at least 3 months prior to the interview were included in this study. Each patient was clinically examined by training doctor on arrival to clinic and then every 3 months. The examination included; personal history, blood pressure, and through cardiovascular examination and recorded. Demographic data, special habits, body mass index, medication used and other laboratory data were registered. Collected data was coded and enter into Pc for statistical analysis. Results: The total number of patient with hypertension (HTN) presented into Cardiac Centre were 277. Of them 187 (67.5%) Were males and 90 (32.5%) were females, their age was ranged from 27 to 100 year with mean age of 57.5 ± 12.3. 61 patients (22.0%) had stage I hypertension (HTN) and stage II (HTN) was found in 182 Patients (65.7%). Of the total cases target BP controlled was achieved in 34 patients (12.3%). Several risk factors have been significantly associated with uncontrolled hypertension and these were; ischemic heart disease, elder age, left ventricular hypertrophy and renal impairment. There were no significant association between uncontrolled hypertension and other variables (Gender, Qat chewing, BMI, duration of hypertension and associated disease as diabetes mellitus, Cerebrovascular accident, medications &amp; blood cholesterol level). Conclusion: Prevalence of uncontrolled hypertension was high in individuals with concomitant hypertension and comorbidity factors. IHD, renal impairment aging and left ventricular hypertrophy are the most important determinants of uncontrolled hypertension.

Antihypertensive treatment and blood pressure trends among South African adults: A repeated cross-sectional analysis of a population panel survey.

BackgroundRecent findings suggest a decline in mean blood pressure and prevalence of uncontrolled hypertension in the South African adult population in the last decade, in contrast with the increase previously observed. This study aimed at quantifying the contribution of antihypertensive treatment to this decline.MethodsWe used data from the four waves of the National Income Dynamics Study between 2008 and 2015 and analysed changes in systolic (SBP) and diastolic blood pressure (DBP) and prevalence of uncontrolled hypertension among South African adults (15 years and above). We compared the observed changes with a counterfactual scenario in which the impact of antihypertensive treatment was estimated by censored regression and removed, with and without adjustment for BMI, waist circumference, alcohol use and smoking.ResultsDuring the study period, the prevalence of antihypertensive treatment rose from 13.1% to 17.6% among women and from 5.3% to 8.2% among men. Concurrently–despite worsening trends in major biobehavioural risk factors for elevated blood pressure–mean SBP decreased in both genders, DBP decreased among women and was stable among men. The odds of uncontrolled hypertension decreased by 4%/year among women and 1%/year among men. After removing the treatment effect, the downward trend in the odds of uncontrolled hypertension was reduced to 1%/year among women and completely offset among men. Among those 55 years and older, but not among younger subjects, treatment effects also explained most of the observed decreases in mean SBP and DBP.ConclusionsAmong South African adults, we infer that diffusion of antihypertensive treatment contributed substantially to the downward trend in the prevalence of uncontrolled hypertension observed between 2008 and 2015. The marked decrease in SBP and uncontrolled hypertension found among younger participants could not be explained by treatment nor by the changing distribution of the measured risk factors available in this study, and requires further investigation.

Process evaluation of a randomised controlled trial of a pharmacological strategy to improve hypertension control: protocol for a qualitative study

IntroductionGlobally, the prevalence of uncontrolled hypertension is high, particularly in low- and middle-income countries. There is a critical need for strategies to improve hypertension control. The early use of a...

Prevalence and factors affecting uncontrolled hypertension among hypertensive patients in a rural community, Thailand

Introduction Hypertension is a non-communicable disease, considered as a major problem of public health worldwide including Thailand. National Health Education Standards indicate that the prevalence of uncontrolled hypertension in hypertensive patients is about 19.5%. Thus, people in Thailand are likely to suffer from chronic disease as well as complications of hypertension, which potentially raises the risk of cardiovascular disease and kidney disease. These results in lower quality of life among hypertensive patients and further contribute to society and economic problems. Objective To determine the prevalence and associated factors of blood pressure control in hypertensive patients in Baan Na Yao community, Chachoengsao Province and Baan Phra Ploeng community, Sa Kaeo Province. Material and methods A cross-sectional study was performed. Blood pressure measurement and anthropometric data were measured and recorded. Standardized questionnaires were used in quantitative study to collect demographic data and factors associated with blood pressure control. The factors included dietary behaviors, physical activities, antihypertensive medication used and information of healthcare service. The collected data were processed using statistical analysis. Results The sample of hypertensive population from Baan Na Yao was 178 (43.8%) and Phra Phloeng was 228 (56.2%). The majority of hypertensive patients were female (72.4%). The prevalence of all age groups was mostly in the range between 60 to 69 years old (38.4%). The overall prevalence of uncontrolled hypertension among hypertensive patients was 54.4%. Multivariate logistic regression analysis was performed. The factors associated with uncontrolled hypertension including poor drug adherence, neck circumference more than or equals to 35.75 centimeters in male and 32.75 centimeters in female, adding fish sauce to meals, and sedentary hours of more than six per day. Conclusion Uncontrolled hypertension is a major problem in the rural community. Therefore, primary care unit (PCU) and village health volunteers have an important role to educate people and patients in the rural community to fully understand and be aware of their own disease condition in order to maintain their quality of life.

Prevalence and associated factors of uncontrolled hypertension among Thai patients with hypertension: A nationwide cross-sectional survey

Background Hypertension is the most common causes of cardiovascular diseases. The information on the prevalence of uncontrolled hypertension in Thailand is lacking. The objectives of this study were to determine prevalence of uncontrolled hypertension among Thai patients with hypertension and to determine factors associated with uncontrolled hypertension in a nationwide survey. Methods A cross-sectional study to assess national outcomes among patients with hypertension who visited 831 public hospitals in Thailand was conducted in 2015 to evaluate status of care among patients with hypertension aged at least 18 years who received medical treatment in the target hospital for the last 12 months. Results A total of 32,440 patients with hypertension were included in this study. Uncontrolled hypertension was detected among 8312 patients (25.6%). Multivariate analysis was conducted to determine which factors were most associated with uncontrolled hypertension, and the results showed age AORs 0.97 (95% CI: 0.96–0.98), diabetes comorbidity AORs 1.35 (95% CI: 1.13–1.60), waist circumferences ≥ 90 cm. AORs 1.18 (95% CI: 1.04–1.34), body mass index (BMI) ≥ 30 kg/m2 AORs 1.37 (95% CI: 1.15–1.62) and uric acid level ≥ 7 mg/dL AORs1.15 (95% CI: 1.01–1.30) were the highest associated factors for uncontrolled hypertension in this population. Conclusion Our data emphasized that uncontrolled hypertension was a problem among patients with hypertension. The results of this study could be used to recommend health information be provided to patients with hypertensions having comorbidity or any risk factors to be aware of uncontrolled hypertension and its complication.

FATORES ASSOCIADOS À HIPERTENSÃO ARTERIAL NÃO CONTROLADA EM PACIENTES ATENDIDOS EM UNIDADES DE ATENÇÃO PRIMÁRIA

Introdução: A Hipertensão Arterial Sistêmica constitui-se como uma das principais causas para o desenvolvimento de afecções cardiovasculares, sendo o controle pressórico a melhor alternativa para sua prevenção. Objetivo: Avaliar a prevalência de Hipertensão Arterial não controlada e seus fatores associados em pacientes atendidos em unidades de atenção primária. Métodos: Estudo transversal com indivíduos em tratamento em Unidades de Saúde do Distrito Sanitário Cabula-Beirú na cidade do Salvador, Bahia, de março a julho de 2013. Análises bivariadas e multivariadas utilizando a regressão logística foram realizadas. A magnitude da associação entre as variáveis analisadas e o não controle pressórico foi estimada pelo cálculo da razão de chances (IC95%) e regressão logística. Os dados foram analisados pelo programa Stata e o projeto foi aprovado pelo Comitê de Ética em Pesquisa da Universidade do Estado da Bahia. Resultados: Destes, 159 (53,5%) apresentavam hipertensão arterial não controlada. A baixa escolaridade (OR=1,71; IC95%: 1,02 – 2,86) e renda familiar (OR=4,09; IC95%: 1,03 – 15,21), a cor da pele preta ou parda (OR=2,64; IC95%:0,97 – 6,32) e a obesidade (OR=2,37; IC95%: 1,09 – 5,17) se mostraram associados a falta de controle dos níveis pressóricos. A presença de diabetes concomitante (OR=0,56; IC95%: 0,34 – 0,95) configurou-se como fator de proteção. Conclusão: Os resultados sugerem uma elevada prevalência de hipertensão arterial não controlada e sua associação com fatores sociais, hábitos de vida e patologias concomitantes. O conhecimento destas características pode proporcionar um planejamento mais específico de ações de promoção e prevenção de saúde para esses subgrupos na Atenção Primária à saúde.

Morning hypertension is more common in elderly hypertensive patients with controlled documented office blood pressure in primary care clinics: the Minhang study.

Increased morning blood pressure (BP) has been associated with fatal and nonfatal cardiovascular events, especially in Asians. To detect the control status of home BP, we performed a home BP monitoring study, including elderly patients with hypertension who had controlled documented office BP in Chinese primary care clinics. In 707 participants from Xinzhuang County Hospital in Shanghai, the home BP was measured by a memory-equipped device three times daily for seven consecutive days. The prevalence of uncontrolled hypertension was 51.3% in the morning and 42% in the evening. Uncontrolled morning hypertension was associated with age [odds ratio (OR): 1.074; 95% confidence interval (CI): 1.041-1.108], office SBP (OR: 1.027; 95% CI: 1.015-1.039), office DBP (OR: 1.042; 95% CI: 1.021-1.064), and the number of antihypertensive drugs taken (OR: 1.387; 95% CI: 1.059-1.817), whereas it was inversely associated with the use of long-acting antihypertensive drugs (OR: 0.588; 95% CI: 0.355-0.973). Compared with office BP, the home morning BP showed a more significant association with age and short-acting antihypertensive drugs. The prevalence of uncontrolled home BP is high in elderly Chinese hypertensive patients, especially in the morning, and home BP monitoring might be a feasible method for detecting it. The use of long-acting antihypertensive drugs might help to improve morning hypertension.

Effect of a Community Health Worker–Led Multicomponent Intervention on Blood Pressure Control in Low-Income Patients in Argentina

Despite extensive knowledge of hypertension treatment, the prevalence of uncontrolled hypertension is high and increasing in low- and middle-income countries. To test whether a community health worker-led multicomponent intervention would improve blood pressure (BP) control among low-income patients with hypertension. A cluster randomized trial was conducted in 18 centers for primary health care within a national public system providing free medications and health care to uninsured patients in Argentina. A total of 1432 low-income adult patients with uncontrolled hypertension were recruited between June 2013 and April 2015 and followed up to October 2016. Nine centers (743 patients) were randomized to the multicomponent intervention, which included a community health worker-led home intervention (health coaching, home BP monitoring, and BP audit and feedback), a physician intervention, and a text-messaging intervention over 18 months. Nine centers (689 patients) were randomized to usual care. The coprimary outcomes were the differences in systolic and diastolic BP changes from baseline to the end of follow-up of patients with hypertension. Secondary outcomes included the proportion of patients with controlled hypertension (BP <140/90 mm Hg). Three BP measurements were obtained at each of 2 baseline and 2 termination visits using a standard protocol, the means of which were used for analyses. Of 1432 participants (mean age, 55.8 years [SD, 13.3]; 772 women [53.0%]), 1357 (94.8%) completed the trial. Baseline mean systolic BP was 151.7 mm Hg for the intervention group and 149.8 mm Hg for the usual care group; the mean diastolic BP was 92.2 mm Hg for the intervention group and 90.1 mm Hg for the usual care group. Systolic BP reduction from baseline to month 18 was 19.3 mm Hg (95% CI, 17.9-20.8 mm Hg) for the intervention group and 12.7 mm Hg (95% CI, 11.3-14.2 mm Hg) for the usual care group; the difference in the reduction was 6.6 mm Hg (95% CI, 4.6-8.6; P < .001). Diastolic BP decreased by 12.2 mm Hg (95% CI, 11.2-13.2 mm Hg) in the intervention group and 6.9 mm Hg (95% CI, 5.9-7.8 mm Hg) in the control group; the difference in the reduction was 5.4 mm Hg (95% CI, 4.0-6.8 mm Hg; P < .001). The proportion of patients with controlled hypertension increased from 17.0% at baseline to 72.9% at 18 months in the intervention group and from 17.6% to 52.2% in the usual care group; the difference in the increase was 20.6% (95% CI, 15.4%-25.9%; P < .001). No adverse events were reported. Low-income patients in Argentina with uncontrolled hypertension who participated in a community health worker-led multicomponent intervention experienced a greater decrease in systolic and diastolic BP than did patients who received usual care over 18 months. Further research is needed to assess generalizability and cost-effectiveness of this intervention and to understand which components may have contributed most to the outcome. clinicaltrials.gov Identifier: NCT01834131.

Immunological Aspects of Hypertension.

Hypertension is a leading cause of morbidity and mortality worldwide, being the major risk factor for stroke, heart failure and kidney diseases. During past decades, several therapies have been developed to afford an optimal regulation of blood pressure levels. However, the prevalence of uncontrolled hypertension still represents an unsolved problem, with a number of patients resistant as well to all ongoing antihypertensive treatments, raising unsolved mechanistic challenges. In the last years, the most attractive novelty in hypertension research postulated that immune system may have a crucial role in blood pressure elevation, as well as in end-organ damage. Here we briefly review the most important contribution revealing the role of innate and adaptive immune system in hypertension. Moreover, we discuss evidence showing that, in the regulation of body hemodynamics, the immune system and the autonomic nervous systems serve as two major sensory organs whose interaction is crucial for blood pressure increase and target organ damage in hypertension.

Uncontrolled Hypertension and Its Determinants in Patients with Concomitant Type 2 Diabetes Mellitus (T2DM) in Rural South Africa.

BackgroundPaucity of data on the prevalence, treatment and control of hypertension in individuals living with type 2 diabetes mellitus (T2DM) in the rural communities of South Africa may undermine efforts to reduce the morbidity and mortality associated with cardiovascular diseases. This study examines the socio-demographic and clinical determinants of uncontrolled hypertension among individuals living with T2DM in the rural communities of Mthatha, South Africa.MethodsThis cross-sectional study involved a serially selected sample of 265 individuals living with T2DM and hypertension at Mthatha General Hospital, Mthatha. Uncontrolled hypertension was defined as systolic blood pressure greater than or equal to 140mmHg and diastolic blood pressure greater than or equal to 90mmHg in accordance with the Eight Joint National Committee Report (JNC 8) (2014). We performed univariate and multivariate logistic regression analyses to identify the significant determinants of uncontrolled hypertension.ResultsOf the total participants (n = 265), the prevalence of uncontrolled hypertension was 75.5% (n = 200). In univariate analysis of all participants, male gender (p = 0.029), age≥65 years (p = 0.016), unemployed status (p<0.0001), excessive alcohol intake (p = 0.005) and consumption of western-type diet (p<0.0001) were positively associated with uncontrolled hypertension. In multivariate logistic regression (LR method) analysis, unemployed status (p<0.0001), excessive alcohol intake (p = 0.007) and consumption of western-type diet (p<0.0001) were independently and significantly associated with uncontrolled hypertension. There is significant association between increasing number and classes of anti-hypertensive drugs and uncontrolled hypertension (p = 0.05 and 0.02, respectively).ConclusionPrevalence of uncontrolled hypertension was high in individuals with concomitant hypertension and T2DM in the study population. Male sex, aging, clinic inertia, unemployed status and nutritional transitions are the most important determinants of uncontrolled hypertension in T2DM in Mthatha, South Africa. Treatment to blood pressure targets, though feasible in our setting, would require concerted efforts by addressing these determinants and clinic inertia.

Comparison of hypertension healthcare outcomes among older people in the USA and England

BackgroundThe USA and England have very different health systems. Comparing hypertension care outcomes in each country enables an evaluation of the effectiveness of each system.MethodThe English Longitudinal Study of Ageing...

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Objective: Although many papers reported that the occurrence of cardiovascular disease (CVD) increased after disaster, there is no report about specific method for the control of risk for CVD after disaster. Design and method: We have begun to implement the web-based Disaster Cardiovascular Prevention (DCAP) network in the survivors of the Great East Japan Earthquake (March 2011). We enrolled and followed up 237 patients in DCAP system to control disaster hypertension in Minamisanriku-town. Results: The average home BP was 151.5 ± 19.9/ 87.1 ± 10.2 mmHg on May 2011. The prevalence of uncontrolled hypertension (>135/85 mmHg) was 54.3%. Interindividual BP during winter of the first year disaster occurred (December 2011) tended to be lowerthan that of summer in the same year (August, 2011) (135.7 ± 12.5/78.7 ± 9.7 mmHg vs 138.6 ± 16.4/79.7 ± 11.0 mmHg, P = 0.074 for SBP, P = 0.368 for DBP). In the next year, interindividual BP on November 2012 was significantly higher than that of summer in the same year (August 2012) (129.3 ± 10.7/ 76.3 ± 10.2 mmHg vs 122.7 ± 9.5/72.4 ± 9.3 mmHg, P < 0.001 for SBP, P < 0.001 for DBP). The monthly average BP following to November, 2012 did not increase. The average home BP at final follow up in this study was 124.0 ± 8.2/ 73.3 ± 9.5 mmHg and the prevalence of uncontrolled hypertension (>135/85mmHg) was 3.2% on June 2013. Conclusions: DCAP system could provide the management of disaster hypertension and strict BP control in the disaster area.

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Objective: Prevalence of hypertension (HTN) is high after solid organ transplantation (SOT) and has been associated to graft failure, death-censored graft failure and death. The Swiss Transplant Cohort Study has enrolled SOT participants prospectively since 2008. No data on the prevalence of HTN and poorly controlled HTN has been reported from this cohort so far. The objective was therefore to determine the prevalence of HTN and poorly controlled HRN Design and method: Patients’ characteristics including Blood pressure (BP) data were recorded at 6 and 12 months. HTN was defined as BP > 140/90 mmHg or the use of antihypertensive drugs. Uncontrolled HTN was defined as BP > 140/90 mmHg despite the use of antihypertensive drugs. Data from 1236 participants were available at baseline (time of SOT). Results: 64.8% of the participants were male, mean age was 52.0 ± 13.1 years (mean ± standard deviation), mean body mass index was 25.0 ± 13,1 Kg/m2. Table 1.Prevalence of HTN and poorly controlled HTN 6 and 12 month after SOT.At 6 and 12 months, the prevalence of HTN was different among the different organs (p < 0.001). The prevalence of uncontrolled HTN among the different organs was different at 6 months (p = 0.013) but not at 12 months (p = 0.080). In multivariate analysis age was associated with an increased risk of uncontrolled HTN at 6 and 12 months. Sex (male) and the number of antihypertensive drug used were associated with HTN at 6 months. Conclusions: The prevalence of HTN after SOT is high but dependent of the organ transplanted. Despite the use of antihypertensive drugs in most SOT patients, uncontrolled HTN is frequent, particularly in kidney transplants.

Abstract P022: Uncontrolled Hypertension and Lifestyle Factors among US Adults with Disabilities

Introduction: While hypertension is a key treatable risk factor for cardiovascular disease, it is not controlled in an estimated 36 million US adults. Previous research has shown that nearly half of adults with disabilities have hypertension and that adults with disabilities are more likely to have hypertension than those without disabilities. However, no study has documented the prevalence of uncontrolled hypertension among the disability population. Our objectives were 1) to determine the prevalence of uncontrolled hypertension among adults with a disability, and 2) estimate the prevalence of awareness, treatment with blood pressure (BP)-lowering medication, and lifestyle factors among adults with disabilities who have uncontrolled hypertension. Methods: Using nationally-representative data from the 2001-2010 National Health and Nutrition Examination Survey for 10,805 participants aged ≥20 years with a disability (self-reported limitation in cognition, hearing, vision, or mobility), we examined the prevalence of hypertension (measured systolic BP ≥140, diastolic BP ≥90 or self-reported use of BP-lowering medication) and uncontrolled hypertension (systolic BP ≥140 or diastolic BP ≥90). Among those with uncontrolled hypertension, we estimated the prevalence of awareness (ever told by a doctor that had hypertension), treatment (self-reported use of BP-lowering medication), and lifestyle factors (measured body mass index and dietary sodium intake and self-reported aerobic physical activity and cigarette smoking). Results: Nearly 38% of US adults have a disability. Overall 46.0% (nearly 37 million) of US adults with disabilities have hypertension. Of those, nearly 20 million (52.4%) had uncontrolled hypertension. Over half of those with uncontrolled hypertension were aware and treated (52.9%), 13.6% were aware but untreated, and 33.4% were unaware. Among those with uncontrolled hypertension 40.5% were obese, 52.1% were physically inactive (had no bouts of aerobic physical activity per week that lasted ≥10 minutes), 18.2% were current smokers, and 62.0% had an average sodium intake of ≥2,300 mg per day. Conclusion: Over half of the 37 million adults with disabilities who have hypertension do not have it controlled; and of those, one third are unaware they have hypertension. This study highlights the need to regularly measure and monitor blood pressure among adults with disabilities. It also identifies adults with disabilities as an important population to include in public health efforts that support and encourage healthy behaviors that might improve BP control and lower risk for cardiovascular disease.

Uncontrolled hypertension by the 2014 evidence-based guideline: results from NHANES 2011-2012.

To look at the prevalence of uncontrolled hypertension in the population using various hypertension guidelines [Seventh Joint National Committee (JNC 7), European Society of Hypertension (ESH)/European Society of Cardiology (ESC) and Canadian Hypertension Education Program (CHEP)] and to assess the predictors of being reclassified to controlled hypertension based on the 2014 evidence-based guideline (2014 EBG) in comparison to JNC 7. Using the National Health and Nutrition Examination Survey for 2011-2012, the prevalence of uncontrolled hypertension in the population was ascertained using different guidelines, including 2014 EBG, JNC 7, ESH/ESC and CHEP. Prevalence of uncontrolled hypertension was further examined based on subgroups by age, sex, race and presence of chronic kidney disease or diabetes. Predictors to be reclassified to controlled hypertension by the 2014 EBG were assessed using multivariable logistic regression. Prevalence of uncontrolled hypertension was 12.8% by the 2014 EBG in comparison to 16.6% by JNC 7, 13.6% by ESH/ESC and 15.6% by CHEP (P < 0.001). As per JNC 7, 23.0% of those with uncontrolled hypertension were reclassified to controlled hypertension by the 2014 EBG. Those most likely to be reclassified to controlled hypertension were older, females and those with diabetes. On the basis of the updated 2014 evidence-based high blood pressure guideline, the percentage of the US population labeled as suffering from uncontrolled hypertension has changed from 16.6 to 12.8%. It is important to note that this change is a reflection of the modified blood pressure targets and not a change in the actual levels of blood pressure control in the population. The greatest impact of reclassification is on elderly, females and those with diabetes.

Trends in blood pressure among adults with hypertension: United States, 2003 to 2012.

The aim of this study is to describe trends in the awareness, treatment, and control of hypertension; mean blood pressure; and the classification of blood pressure among US adults 2003 to 2012. Using data from the National Health and Nutrition Examination Survey 2003 to 2012, a total of 9255 adult participants aged ≥18 years were identified as having hypertension, defined as measured blood pressure ≥140/90 mm Hg or taking prescription medication for hypertension. Awareness and treatment among hypertensive adults were ascertained via an interviewer administered questionnaire. Controlled hypertension among hypertensive adults was defined as systolic blood pressure <140 mm Hg and diastolic blood pressure <90 mm Hg. Blood pressure was categorized as optimal blood pressure, prehypertension, and stage I and stage II hypertension. Between 2003 and 2012, the percentage of adults with controlled hypertension increased (P-trend <0.01). Hypertensive adults with optimal blood pressure and with prehypertension increased from 13% to 19% and 27% to 33%, respectively (P-trend <0.01 for both groups). Among hypertensive adults who were taking antihypertensive medication, uncontrolled hypertension decreased from 38% to 30% (P-trend <0.01). Similarly, a decrease in mean systolic blood pressure was observed (P-trend <0.01); however, mean diastolic blood pressure remained unchanged. The trend in the control of blood pressure has improved among hypertensive adults resulting in a higher percentage with blood pressure at the optimal or prehypertension level and a lower percentage in stage I and stage II hypertension. Overall, mean systolic blood pressure decreased as did the prevalence of uncontrolled hypertension among the treated hypertensive population.

Abstract 12030: Trends in Blood Pressure Among Adults With Hypertension: United States, 2003-2012

Objectives: To describe trends in the awareness, treatment and control of hypertension; mean blood pressure; and the classification of blood pressure among U.S. adults 2003-2012. Methods and Results: Using data from the National Health and Nutrition Examination Survey 2003-2012, a total of 9,255 adult participants aged 18 and older were identified as having hypertension, defined as measured blood pressure ≥ 140/90 mm Hg or taking prescription medication for hypertension. Awareness and treatment among hypertensive adults were ascertained via an interviewer administered questionnaire. Controlled hypertension among hypertensive adults was defined as systolic blood pressure &lt;140 mm Hg and diastolic blood pressure &lt; 90 mm Hg. Blood pressure was categorized as optimal blood pressure, prehypertension, stage I hypertension and stage II hypertension. Between 2003 and 2012, the percent of adults with controlled hypertension increased ( p -trend &lt;0.01). Hypertensive adults with optimal blood pressure and with prehypertension increased from 13% to 19% and 27% to 33%, respectively ( p - trend &lt; 0.01). Among hypertensive adults who were taking anti-hypertensive medication, uncontrolled hypertension decreased from 38% to 30% ( p -trend &lt;0.01). Similarly, a decrease in mean systolic blood pressure was observed ( p -trend &lt;0.01); however, mean diastolic blood pressure remained unchanged. Conclusion: The trend in the control of blood pressure has improved among hypertensive adults resulting in a higher percent with blood pressure at the optimal or prehypertension level and a lower percent in stage I and stage II hypertension. Overall, mean systolic blood pressure decreased as did the prevalence of uncontrolled hypertension among the treated hypertensive population.