Trends in Prevalence and Control of Hypertension According to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) Guideline

Kirsten S Dorans, Katherine T Mills, Yang Liu, Jiang He, Kirsten S Dorans, Katherine T Mills, Yang Liu, Jiang He

Abstract

Background: Hypertension is a major risk factor for cardiovascular disease and all-cause mortality. Compared with prior guidelines, the 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension guideline recommends lower blood pressure thresholds for defining hypertension, for initiating antihypertensive medication, and for antihypertensive medication treatment goals.

Methods and results: To better understand potential impacts of the 2017 guideline, we studied trends in mean systolic blood pressure and diastolic blood pressure, prevalence and burden of hypertension, and proportion of controlled hypertension in the US adult population aged ≥20 from 1999 through 2016. We used data from 38 276 adults from the National Health and Nutrition Examination Survey. Age-standardized prevalence of hypertension decreased from 48.4% in 1999-2000 to 45.4% in 2015-2016. However, absolute burden of hypertension consistently increased, from 87.0 million in 1999-2000 to 108.2 million in 2015-2016. The age-standardized proportion of controlled hypertension among adults receiving antihypertensive pharmacologic treatment increased from 1999-2000 (25.6%) to 2015-2016 (43.5%). There was not consistent improvement in control throughout the full period among non-Hispanic blacks, individuals aged ≥60, or those with diabetes mellitus, chronic kidney disease, or high cardiovascular disease risk.

Conclusions: Based on the 2017 guideline, from 1999 to 2016, the age-standardized prevalence of hypertension decreased and the proportion of control among those treated for hypertension improved. However, the absolute hypertension burden increased. Among those treated, the control rate did not consistently improve in all subgroups. These data emphasize the need for continuous efforts in the prevention and control of hypertension in the US general population.

Keywords: epidemiology; high blood pressure; hypertension; risk factor.

© 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Figures

Figure 1
Figure 1
Study population.
Figure 2
Figure 2
Age‐standardized and age‐specific mean systolic blood pressure (BP) in the US population aged ≥20, by NHANES cycle. A, Age‐standardized mean systolic blood pressure (BP) among women (blue) and men (green). B, Age‐standardized mean systolic BP among non‐Hispanic whites (blue), non‐Hispanic blacks (green), and Mexican Americans (orange). C, Age‐standardized mean systolic BP among ages 20 to 39 (blue), 40 to 59 (green), and ≥60 (orange) years. D, Age‐standardized mean systolic BP among individuals treated for hypertension (blue) and among those not receiving hypertension treatment (green).
Figure 3
Figure 3
Age‐standardized and age‐specific mean diastolic blood pressure (BP) in the US population ages 20 and older, by NHANES cycle. A, Age‐standardized mean diastolic blood pressure (BP) among women (blue) and men (green). B, Age‐standardized mean diastolic BP among non‐Hispanic whites (blue), non‐Hispanic blacks (green), and Mexican Americans (orange). C, Age‐standardized mean diastolic BP among ages 20 to 39 (blue), 40 to 59 (green), and ≥60 (orange) years. D, Age‐standardized mean diastolic BP among individuals treated for hypertension (blue) and among those not receiving hypertension treatment (green).
Figure 4
Figure 4
Absolute number of individuals (in thousands) with hypertension (2017 AHA/ACC Guideline*) in the US population ages 20 and older, by NHANES cycle. *2017 American College of Cardiology/American Heart Association (ACC/AHA) guideline for the prevention, detection, evaluation and management of high blood pressure in adults.

References

    1. Danaei G, Ding EL, Mozaffarian D, Taylor B, Rehm J, Murray CJL, Ezzati M. The preventable causes of death in the United States: comparative risk assessment of dietary, lifestyle, and metabolic risk factors. PLoS Med. 2009;6:e1000058.
    1. GBD 2015 Risk Factors Collaborators . Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:1659–1724.
    1. Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, Chen J, He J. Global disparities of hypertension prevalence and control: a systematic analysis of population‐based studies from 90 countries. Circulation. 2016;134:441–450.
    1. US Burden of Disease Collaborators . The state of US health, 1990–2010: burden of diseases, injuries, and risk factors. JAMA. 2013;310:591–608.
    1. Forouzanfar MH, Liu P, Roth GA, Ng M, Biryukov S, Marczak L, Alexander L, Estep K, Hassen Abate K, Akinyemiju TF, Ali R, Alvis‐Guzman N, Azzopardi P, Banerjee A, Bärnighausen T, Basu A, Bekele T, Bennett DA, Biadgilign S, Catalá‐López F, Feigin VL, Fernandes JC, Fischer F, Gebru AA, Gona P, Gupta R, Hankey GJ, Jonas JB, Judd SE, Khang Y‐H, Khosravi A, Kim YJ, Kimokoti RW, Kokubo Y, Kolte D, Lopez A, Lotufo PA, Malekzadeh R, Melaku YA, Mensah GA, Misganaw A, Mokdad AH, Moran AE, Nawaz H, Neal B, Ngalesoni FN, Ohkubo T, Pourmalek F, Rafay A, Rai RK, Rojas‐Rueda D, Sampson UK, Santos IS, Sawhney M, Schutte AE, Sepanlou SG, Shifa GT, Shiue I, Tedla BA, Thrift AG, Tonelli M, Truelsen T, Tsilimparis N, Ukwaja KN, Uthman OA, Vasankari T, Venketasubramanian N, Vlassov VV, Vos T, Westerman R, Yan LL, Yano Y, Yonemoto N, Zaki MES, Murray CJL. Global burden of hypertension and systolic blood pressure of at least 110 to 115 mm Hg, 1990–2015. JAMA. 2017;317:165–182.
    1. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Age‐specific relevance of usual blood pressure to vascular mortality: a meta‐analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360:1903–1913.
    1. Wei Y‐C, George NI, Chang C‐W, Hicks KA. Assessing sex differences in the risk of cardiovascular disease and mortality per increment in systolic blood pressure: a systematic review and meta‐analysis of follow‐up studies in the United States. PLoS One. 2017;12:e0170218.
    1. Bundy JD, Li C, Stuchlik P, Bu X, Kelly TN, Mills KT, He H, Chen J, Whelton PK, He J. Systolic blood pressure reduction and risk of cardiovascular disease and mortality: a systematic review and network meta‐analysis. JAMA Cardiol. 2017;2:775–781.
    1. Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SCJ, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA Sr, Williamson JD, Wright JT Jr. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71:e13–e115. DOI:
    1. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JLJ, Jones DW, Materson BJ, Oparil S, Wright JTJ, Roccella EJ; National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure Education Program Coordinating Committee . The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289:2560–2572.
    1. James PA, Oparil S, Carter BL, Cushman WC, Dennison‐Himmelfarb C, Handler J, Lackland DT, LeFevre ML, MacKenzie TD, Ogedegbe O, Smith SC, Svetkey LP, Taler SJ, Townsend RR, Wright JT, Narva AS, Ortiz E. 2014 Evidence‐based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311:507–520.
    1. Qaseem A, Wilt TJ, Rich R, Humphrey LL, Frost J, Forciea MA. Pharmacologic treatment of hypertension in adults aged 60 years or older to higher versus lower blood pressure targets: a clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians. Ann Intern Med. 2017;166:430–437.
    1. SPRINT Research Group , Wright JT, Williamson JD, Whelton PK, Snyder JK, Sink KM, Rocco M V, Reboussin DM, Rahman M, Oparil S, Lewis CE, Kimmel PL, Johnson KC, Goff DC, Fine LJ, Cutler JA, Cushman WC, Cheung AK, Ambrosius WT. A randomized trial of intensive versus standard blood‐pressure control. N Engl J Med. 2015;373:2103–2116.
    1. Muntner P, Carey RM, Gidding S, Jones DW, Taler SJ, Wright JTJ, Whelton PK. Potential U.S. population impact of the 2017 American College of Cardiology/American Heart Association high blood pressure guideline. J Am Coll Cardiol. 2018;71:109–118.
    1. Zipf G, Chiappa M, Porter KS, Ostchega Y, Lewis BG, Dostal J. National health and nutrition examination survey: plan and operations, 1999–2010. Vital Health Stat. 2013;1:1–37.
    1. American Diabetes Association . Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010;33(suppl 1):S62–S69.
    1. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF III, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150:604–612.
    1. Goff DC, Lloyd‐Jones DM, Bennett G, Coady S, D'Agostino RB, Gibbons R, Greenland P, Lackland DT, Levy D, O'Donnell CJ, Robinson JG, Schwartz JS, Shero ST, Smith SC, Sorlie P, Stone NJ, Wilson PWF. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129:S49–S73.
    1. Ostchega Y, Dillon CF, Lindle R, Carroll M, Hurley BF. Isokinetic leg muscle strength in older Americans and its relationship to a standardized walk test: data from the National Health and Nutrition Examination Survey 1999–2000. J Am Geriatr Soc. 2004;52:977–982.
    1. Howden L, Meyer J. Age and sex composition: 2010. 2010 Census Briefs. May 2011. Washington, DC: US Census Bureau; 2011.
    1. Crim MT, Yoon SS, Ortiz E, Wall HK, Schober S, Gillespie C, Sorlie P, Keenan N, Labarthe D, Hong Y. National surveillance definitions for hypertension prevalence and control among adults. Circ Cardiovasc Qual Outcomes. 2012;5:343–351.
    1. National Cancer Institute . Joinpoint trend analysis software (Version 4.5.0.1). 2017. Available at: . Accessed November 21, 2017.
    1. Kim HJ, Fay MP, Feuer EJ, Midthune DN. Permutation tests for joinpoint regression with applications to cancer rates. Stat Med. 2000;19:335–351.
    1. Fryar CD, Ostchega Y, Hales CM, Zhang G, Kruszon‐Moran D. Hypertension prevalence and control among adults: United States, 2015–2016. NCHS data brief, no 289. Hyattsville, MD: National Center for Health Statistics; 2017.
    1. Yoon SS, Gu Q, Nwankwo T, Wright JD, Hong Y, Burt V. Trends in blood pressure among adults with hypertension United States, 2003 to 2012. Hypertension. 2015;65:54–61.
    1. Gu Q, Burt VL, Dillon CF, Yoon S. Trends in antihypertensive medication use and blood pressure control among United States adults with hypertension: the National Health and Nutrition Examination Survey, 2001 to 2010. Circulation. 2012;126:2105–2114.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다