A Population-Based Policy and Systems Change Approach to Prevent and Control Hypertension (2010) / Chapter Skim
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2 Public Health Importance of Hypertension
2 Public Health Importance of Hypertension
Pages 49-74
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From page 49... ...
. Systolic blood pressure is a more important risk factor for cardiovascular disease than diastolic blood pressure (Gu et al., 2008; Klag et al., 1996; Stamler et al., 1993)
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From page 50... ...
Hypertension prevalence estimates derived from the NHANES are defined as systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg and/or receiving antihypertensive medication. The estimated prevalence of hypertension derived from the NHANES 1999-2004 was 28.9 percent of the U.S.
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From page 51... ...
Adult Population: NHANES 1999-2004 Non-Hispanic White Non-Hispanic Black Mexican American Age (years) Men Women Men Women Men Women 18-29 5.5 (1.1)
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From page 52... ...
. Based on guidelines detailed in the Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents, high blood pressure is defined as having systolic and/or diastolic blood pressure that ranks as ≥95th percentile for gender, age, and height (National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents, 2004)
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1.7 (0.5) a Elevated blood pressure was defined as average systolic blood pressure and/or diastolic blood pressure that is ≥95th percentile for gender, age, and height.
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. Current national guidelines recommend three blood pressure measurements on multiple days for a clinical diagnosis of hypertension.
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. Secular Trends in Children Secular trends in mean blood pressure level and hypertension prevalence among children and adolescents ages 8 to 17 years were examined
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. Muntner and colleagues found Ostchega that mean systolic blood pressure increased between 1988-1994 and 19992000.
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. A more recent analysis of NHANES data surveys conducted in 19881994, 1999-2002, and 2003-2006 also shows an overall increase in elevated blood pressure in children and adolescents ages 8 though 17 years (Ostchega et al., 2009)
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From page 58... ...
Figure 2-2 shows the prevalence of elevated blood pressure by gender and race or ethnicity. After conducting multivariate analyses controlling for weight status, age, and race and ethnicity, the authors concluded that the prevalence of elevated blood pressure increased among girls ages 8-17 but had decreased among boys ages 13-17.
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. AWARENESS, TREATMENT, AND CONTROL OF HyPERTENSION IN THE COMMuNITy Treatment and control of hypertension in the community requires that elevated blood pressure be recognized and that individuals with hypertension receive adequate treatment.
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0 APPROACH TO PREVENT AND CONTROL HYPERTENSION FIGuRE 2-3 Residual lifetime risk of hypertension in women and men aged 65 years. Cumulative incidence of hypertension in 65-year-old women and men.
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The actual awareness, treatment, and control rates are likely higher than the NHANES estimates due to the definition of hypertension in the study. In the NHANES, the diagnosis of hypertension was based on blood pressure measurement at a single clinical visit, whereas national guidelines recommend that the classification of hypertension be based on the mean of two or more blood pressure readings taken during two or more office visits (Chobanian et al., 2003)
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1988-1994 1999-2004 1988-1994 1999-2004 1988-1994 1999-2004 Total 68.5 71.8 53.1 61.4 26.1 35.1 Men 61.6 69.3 44.6 57.9 20.7 36.2 Women 74.8 73.9 61.0 64.5 31.2 34.2 Non-Hispanic white 69.1 72.0 54.2 62.1 27.3 36.8 Men 63.0 70.4 46.2 60.0 22.0 39.3 Women 74.7 73.4 61.6 64.0 32.2 34.5 Non-Hispanic black 71.0 75.8 54.8 65.1 24.0 33.4 Men 62.5 67.8 42.3 56.4 16.6 29.9 Women 77.8 81.8 64.6 71.7 30.0 36.0 Mexican American 57.5 61.3 38.6 47.4 16.2 24.3 Men 47.8 55.9 30.9 40.4 13.5 21.4 Women 69.3 66.9 47.8 54.9 19.4 27.4 SOURCE: Adapted from Cutler et al., 2008.
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From page 63... ...
Physician factors related to uncontrolled hypertension include lack of knowledge about guidelines, overestimating guideline adherence, concerns about medication side effects, and limited office visit time. Many barriers to hypertension control in the general population affect African Americans, especially African-American men, disproportionally (Cooper, 2009)
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Therefore, at the request of the committee, the Centers for Disease Control and Prevention (CDC) provided unpublished data of secular trends in mean and median systolic and diastolic blood pressure and hypertension prevalence among children (8-17 years)
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119.7 (0.3) Mean systolic (mm Hg)
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From page 66... ...
whites and 108.9 in blacks in the NHANES 1971-1975 to 105.1 mm Hg in whites and 106.2 in blacks in the NHANES 1988-1994. Mean diastolic blood pressure decreased even more dramatically, from 68.1 mm Hg in whites and 68.1 in blacks to 57.8 mm Hg in whites and 57.3 in blacks.
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From page 67... ...
Figure 2-4 During the late 1980s and the early 2000s, mean systolic blood pressure increased slightly: from 105.1, 106.2, and 105.5 mm Hg in the NHANES 1988-1994 to 107.5, 108.1, and 107.4 mm Hg in the NHANES 20032006 for whites, blacks, and Mexican Americans, respectively.
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From page 68... ...
Risk factor data for overweight, obesity, sodium intake, and hypertension prevalence available from the National Center for Health Statistics (NCHS) Health, United States, 200 report show substantial increases since 1960.
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bSodium intake estimates are based on the average of salt intake from 24-hour recalls for men and women from NHANES data. Data from NHANES 1971-1974 include naturally occurring sodium in foods and that added by processors.
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Data are critical for determining the burden of hypertension, characterizing the patterns among subgroups of the population, assessing changes in the problem over time, and evaluating the success of interventions. Given the challenges posed by the changing methodologies used to collect blood pressure measurements, the committee believes that efforts to strengthen hypertension surveillance and monitoring are critical.
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From page 71... ...
In responding to these recommendations, the DHDSP may want to consider conducting a thorough analytical assessment of available data, including data from the NHANES, to determine if these data are sufficiently comparable for evaluating secular trends of hypertension prevalence in the U.S. population.
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2005. Secular trends in cardiovascular disease risk factors according to body mass index in US adults.
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From page 73... ...
1994. Exercise blood pressure response and 5-year risk of elevated blood pressure in a cohort of young adults: The CARDIA study.
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2009. Trends of elevated blood pressure among children and adolescents: Data from the National Health and Nutrition Examination Survey 1988-2006.
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