Trends In Hypertension Control Research Articles

Trends in Hypertension Control Among United States Adults: Is NHANES the Outlier?

Trends in Hypertension Control Among United States Adults: Is NHANES the Outlier?

Abstract MP64: Trends in Racial Differences in Control of Hypertension, 2008-2014

Background: Racial disparities in blood pressure control in the U.S. have been well documented. In 2010, Kaiser Permanente Southern California (KPSC), a large and diverse integrated health care delivery system that provides care to over 4 million members, implemented a series of changes in health care delivery to address the disparity in hypertension control. Key elements included changes to the care team, patient activation, meaningful use of health information technology, and leadership vision. Methods: We examined trends in hypertension control between 2008 and 2014 by race/ethnicity in KPSC members aged 18 years and older. Patients with hypertension were identified from the KPSC POINT® (Permanente Online Interactive Network Tool) population care management hypertension registry. Blood pressure control was defined according to JNC-7 criteria in the fourth quarter of each calendar year from 2008 through 2014. Results: Between 2008 and 2014, the hypertension population increased from 624,493 to 745,382, while the prevalence was stable (25.9% in 2008 and 25.6% in 2014). During this period, the proportion of Whites and Blacks decreased slightly from 45.4% to 43.0% and 14.3% to 13.5%, respectively, while the proportion of Hispanics and Asian/Pacific Islanders increased from 25.2% to 29.0% and 9.8% to 11.3%, respectively. Hypertension control increased from 74.0% in 2008 to 83.8% in 2014 and increased across age, sex, and racial/ethnic groups (Figure). Blacks had the largest improvement in hypertension control (68.8% to 80.8%), which was primarily driven by those aged 65+ years. The disparity in hypertension control between Whites and Blacks decreased from 6.9% to 5% between 2008 and 2014. Conclusions: While ecologic in nature, the secular increases in hypertension control suggest that implementation of a series of system-wide changes can affect all subpopulations.

Trends in hypertension control among the older population of Spain from 2000 to 2001 to 2008 to 2010: role of frequency and intensity of drug treatment.

The use of antihypertensive medication and hypertension control has significantly increased during recent decades in some developed countries, but the impact of improved drug treatment on blood pressure (BP) control in the population is unknown. Data were taken from 2 surveys representative of the population aged ≥ 60 years in Spain conducted with the same methodology in 2000 to 2001 and in 2008 to 2010. BP was measured 6×. The first BP reading was discarded, and the average of the remaining 3 to 5 BP readings was taken for analysis. Hypertension prevalence was 68.7% in 2000 to 2001 and 66.0% in 2008 to 2010. Between both time periods there was an improvement in hypertension awareness (63.6%-67.7%), drug treatment among those aware (84.5%-87.5%), and BP control among treated hypertensives (30.3%-42.9%). Overall, BP control among all hypertensives increased from 16.3% to 25.4%. After adjustment for age, sex, education, hypertension duration, smoking, alcohol consumption, body mass index, sedentary behavior, diabetes mellitus, cardiovascular disease, and visits to the physician through logistic regression, ≈ 7% of the improvement in BP control among all hypertensives was explained by higher hypertension awareness, and 36.2% was explained by a higher treatment rate. Among the treated hypertensives, 22.6% of the progress in BP control was because of the increase in the number of BP medications used in each patient. BP control among the older hypertensive population in Spain has improved from 2000 to 2001 to 2008 to 2010 because of a higher treatment rate and more intense antihypertensive drug treatment.

Trends in hypertension control by race/ethnicity in a large integrated health care system, 2008-2012

Trends in hypertension control by race/ethnicity in a large integrated health care system, 2008-2012

Abstract P043: National Trends in Hypertension Control 1999-2012 and Projected Impact on Incident Stroke by Age, Sex, and Race: The Cardiovascular Disease Policy Model

Background: Blood pressure (BP) control rates have improved over the decade, as have stroke rates. We determined the impact of secular BP trends on national stroke rates by age, sex, and specifically for US Blacks. Methods: We estimated national BP distributions from NHANES and quantified changes from ‘99-‘04 to ‘07-‘12 by age (35-64, 65-84 years), sex, and separately for Blacks. We used these as inputs to the Cardiovascular Disease Policy Model (CVDPM), a population-based computer simulation of CVD nationally. CVDPM data inputs include the Census, vital statistics, NHANES, national hospitalization data, and Framingham among others. CVDPM has been adapted to US Blacks (CVDPM-AA) using these sources as well as cohorts including ARIC and REGARDS. Both models are calibrated to reproduce event rates in the baseline year and outcomes of intervention studies. We projected changes in incident strokes attributable to changes in BP distribution and also modeled universal BP control (systolic BP <140 mmHg). Baseline values of other CVD risk factors were also included to isolate effects attributable to BP. Results: Among older US adults, the prevalence of systolic BP ≥140 mmHg decreased over the period (Table). Among younger adults, improvements in BP control were only observed in all US and Black women, not US or Black men. The projected benefit from prevented stroke attributable to improvements in BP control is substantial for all older adults and for younger women, and the magnitude is particularly striking for Blacks. Stroke reduction attributable to BP control is not observed in younger men. Universal BP control is projected to have a large impact on incident stroke reduction, at least twice the impact estimated from the secular trends in BP reduction from 1999-2012 in most groups. Conclusions: Recent improvements in BP control are projected to contribute to stroke prevention in all groups in the US, except men younger than 65 years. Additional hypertension control efforts will yield considerable additional benefits in stroke prevention.

Trends in Hypertension Control in the United States

Trends in Hypertension Control in the United States