Prevalence, awareness, and management of hypertension, dyslipidemia, and diabetes among United States adults aged 65 and older

Margaret McDonald, Robin P Hertz, Alan N Unger, Michael B Lustik, Margaret McDonald, Robin P Hertz, Alan N Unger, Michael B Lustik

Abstract

Background: Adults aged 65 and older are disproportionately affected by hypertension, dyslipidemia, and diabetes, which are established risk factors for cardiovascular disease (CVD). Although risk reduction strategies among older adults, including control of CVD risk factors, can lead to a decline in premature CVD morbidity and mortality, the prevalence of these risk factors has generally increased in the past decade among elders and risk factor control rates have been suboptimal. We assess prevalence, awareness, treatment, and control rates among U.S. adults aged 65 and older with respect to hypertension, dyslipidemia, and diabetes and describe predictors associated with awareness and management of these factors.

Methods: Analysis of nationally representative data collected from adults aged 65 and older (n = 3,810) participating in the National Health and Nutrition Examination Survey 1999-2004.

Results: Women have a significantly higher prevalence of hypertension than men (76.6% vs 63.0%) and a significantly lower rate of control when treated pharmacologically (42.9% vs 57.9%). Dyslipidemia prevalence is 60.3% overall, and women are significantly more likely to be aware of their condition than men (71.1% vs 59.1%). Diabetes affects 21.2% of older adults, and 50.9% of prevalent cases are treated pharmacologically. Goal attainment among those treated is problematic for all three conditions-hypertension (48.8%), dyslipidemia (64.9%), and diabetes (50.4%). Having two or more doctor visits annually is associated with goal attainment for dyslipidemia.

Conclusions: Knowledge of cardiovascular health in older adults and understanding gender gaps in awareness can help physicians and policymakers improve disease management and patient education programs.

References

    1. Rosamond W, Flegal K, Friday G, et al. Heart disease and stroke statistics—2007 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2007;115:e69–e171.
    1. U.S. Census Bureau, Population Division. Washington, DC: U.S. Census Bureau; Table 2: Annual estimates of the population by selected age groups and sex for the United States: April 1, 2000 to July 1, 2006 (NC-EST2005-02) Available at: . Accessed on April 11, 2007.
    1. Agency for Healthcare Research and Quality. Rockville, Md: Agency for Healthcare Research and Quality; Total expenses for conditions by site of service: United States, 2004. Medical Expenditure Panel Survey Component Data (generated interactively) Available at: . Accessed on March 16, 2007.
    1. Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) JAMA. 2001;285:2486–2497.
    1. Grundy SM, Cleeman JI, Merz CN, et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation. 2004;110:227–239.
    1. Grundy SM, Benjamin IJ, Burke GL, et al. Diabetes and cardiovascular disease: a statement for healthcare professionals from the American Heart Association. Circulation. 1999;100:1134–1146.
    1. Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42:1206–1252.
    1. Fields LE, Burt VL, Cutler JA, Hughes J, Roccella EJ, Sorlie P. The burden of adult hypertension in the United States 1999 to 2000: a rising tide. Hypertension. 2004;44:398–404.
    1. Hajjar I, Kotchen TA. Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988–2000. JAMA. 2003;290:199–206.
    1. Smith NL, Savage PJ, Heckbert SR, et al. Glucose, blood pressure, and lipid control in older people with and without diabetes mellitus: the Cardiovascular Health Study. J Am Geriatr Soc. 2002;50:416–423.
    1. Heron MP, Smith BL. Deaths: leading causes for 2003. Natl Vital Stat Rep. 2007;55:1–92.
    1. He W, Sengupta M, Velkoff VA, et al. U.S. Census Bureau, Current Population Reports, P23-209. 65+ in the United States: 2005. Washington, DC: U.S. Government Printing Office; 2005; 2005.
    1. Hogan P, Dall T, Nikolov P. Economic costs of diabetes in the US in 2002. Diabetes Care. 2003;26:917–932.
    1. Druss BG, Marcus SC, Olfson M, Tanielian T, Elinson L, Pincus HA. Comparing the national economic burden of five chronic conditions. Health Aff (Millwood) 2001;20:233–241.
    1. National Center for Health Statistics. Hyattsville, Md: National Center for Health Statistics. Centers for Disease Control and Prevention; Centers for Disease Control and Prevention. National Health and Nutrition Examination Survey. Available at: . Accessed on April 11, 2007.
    1. Carroll MD, Lacher DA, Sorlie PD, et al. Trends in serum lipids and lipoproteins of adults, 1960–2002. JAMA. 2005;294:1773–1781.
    1. Cowie CC, Rust KF, Byrd-Holt DD, et al. Prevalence of diabetes and impaired fasting glucose in adults in the U.S. population: National Health And Nutrition Examination Survey 1999–2002. Diabetes Care. 2006;29:1263–1268.
    1. Ong KL, Cheung BM, Man YB, Lau CP, Lam KS. Prevalence, awareness, treatment, and control of hypertension among United States adults 1999–2004. Hypertension. 2007;49:69–75.
    1. Ostchega Y, Dillon CF, Hughes JP, et al. Prevalence, awareness, treatment, and control in older U.S. adults: data from the National Health and Nutrition Examination Survey 1988 to 2004. JAGS. 2007;55:1056–1065.
    1. Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 2003;(26Supp l:):S5–S20.
    1. Cheung BM, Ong KL, Man YB, Lam KS, Lau CP. Prevalence, awareness, treatment, and control of hypertension: United States National Health and Nutrition Examination Survey 2001–2002. J Clin Hypertens (Greenwich) 2006;8:93–98.
    1. Hertz RP, Unger AN, Cornell JA, Saunders E. Racial disparities in hypertension prevalence, awareness, and management. Arch Intern Med. 2005;165:2098–2104.
    1. Izzo JL, Levy DL, Black HR. Importance of systolic blood pressure in older Americans. Hypertension. 2000;35:1021–1024.
    1. Chobanian AV. Isolated systolic hypertension in the elderly. N Engl J Med. 2007;357:789–796.
    1. McBean AM, Huang Z, Virnig BA, Lurie N, Musgrave D. Racial variation in the control of diabetes among elderly Medicare managed care beneficiaries. Diabetes Care. 2003;26:3250–3256.
    1. Huang ES, Sachs GA, Chin MH. Implications of new geriatric diabetes care guidelines for the assessment of quality of care in older patients. Med Care. 2006;44:373–377.
    1. Healthy People 2010, Objectives for Improving Health (Part A: Focus Areas 5, 12) Rockville, Md: U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion; U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Available at . Accessed on April 11, 2007.

Source: PubMed

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