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Circulation. 2014 Nov 4;130(19):1692-9. doi: 10.1161/CIRCULATIONAHA.114.010676. Epub 2014 Oct 20.

Hypertension in the United States, 1999 to 2012: progress toward Healthy People 2020 goals.

Author information

1
From the Care Coordination Institute and University of South Carolina School of Medicine-Greenville, Greenville Health System, Greenville, SC (B.M.E.); Department of Mathematics, College of Charleston, Charleston, SC (J.L.); Medical University of South Carolina and Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (F.N.H.); and Tulane University School of Medicine, New Orleans, LA (K.C.F.). began@ccihealth.org.
2
From the Care Coordination Institute and University of South Carolina School of Medicine-Greenville, Greenville Health System, Greenville, SC (B.M.E.); Department of Mathematics, College of Charleston, Charleston, SC (J.L.); Medical University of South Carolina and Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (F.N.H.); and Tulane University School of Medicine, New Orleans, LA (K.C.F.).

Abstract

BACKGROUND:

To reduce the cardiovascular disease burden, Healthy People 2020 established US hypertension goals for adults to (1) decrease the prevalence to 26.9% and (2) raise treatment to 69.5% and control to 61.2%, which requires controlling 88.1% on treatment.

METHODS AND RESULTS:

To assess the current status and progress toward these Healthy People 2020 goals, time trends in National Health and Nutrition Examination Surveys 1999 to 2012 data in 2-year blocks were assessed in adults ≥18 years of age age-adjusted to US 2010. From 1999 to 2000 to 2011 to 2012, prevalent hypertension was unchanged (30.1% versus 30.8%, P=0.32). Hypertension treatment (59.8% versus 74.7%, P<0.001) and proportion of treated adults controlled (53.3%-68.9%, P=0.0015) increased. Hypertension control to <140/<90 mm Hg rose every 2 years from 1999 to 2000 to 2009 to 2010 (32.2% versus 53.8%, P<0.001) before declining to 51.2% in 2011 to 2012. Modifiable factor(s) significant in multivariable logistic regression modeling include: (1) increasing body mass index with prevalent hypertension (odds ratio [OR], 1.44); (2) lack of health insurance (OR, 1.68) and <2 healthcare visits per year (OR, 4.24) with untreated hypertension; (3) healthcare insurance (OR, 1.69), ≥2 healthcare visits per year (OR, 3.23), and cholesterol treatment (OR, 1.90) with controlled hypertension.

CONCLUSIONS:

The National Health and Nutrition Examination Survey 1999 to 2012 analysis suggests that Healthy People 2020 goals for hypertension ([1] prevalence shows no progress, [2] treatment was exceeded, and [3] control) have flattened below target. Findings are consistent with evidence that (1) obesity prevention and treatment could reduce prevalent hypertension, and (2) healthcare insurance, ≥2 healthcare visits per year, and guideline-based cholesterol treatment could improve hypertension control.

KEYWORDS:

Healthy People Programs; hypertension; nutrition surveys; population characteristics

PMID:
25332288
PMCID:
PMC4221549
DOI:
10.1161/CIRCULATIONAHA.114.010676
[Indexed for MEDLINE]
Free PMC Article

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