Dataset Information

Trends in Blood Pressure Control Among US Adults With Hypertension, 1999-2000 to 2017-2018.

ABSTRACT:

Importance

Controlling blood pressure (BP) reduces the risk for cardiovascular disease.

Objective

To determine whether BP control among US adults with hypertension changed from 1999-2000 through 2017-2018.

Design, setting, and participants

Serial cross-sectional analysis of National Health and Nutrition Examination Survey data, weighted to be representative of US adults, between 1999-2000 and 2017-2018 (10 cycles), including 18?262 US adults aged 18 years or older with hypertension defined as systolic BP level of 140 mm Hg or higher, diastolic BP level of 90 mm Hg or higher, or use of antihypertensive medication. The date of final data collection was 2018.

Exposures

Calendar year.

Main outcomes and measures

Mean BP was computed using 3 measurements. The primary outcome of BP control was defined as systolic BP level lower than 140 mm Hg and diastolic BP level lower than 90 mm Hg.

Results

Among the 51?761 participants included in this analysis, the mean (SD) age was 48 (19) years and 25?939 (50.1%) were women; 43.2% were non-Hispanic White adults; 21.6%, non-Hispanic Black adults; 5.3%, non-Hispanic Asian adults; and 26.1%, Hispanic adults. Among the 18?262 adults with hypertension, the age-adjusted estimated proportion with controlled BP increased from 31.8% (95% CI, 26.9%-36.7%) in 1999-2000 to 48.5% (95% CI, 45.5%-51.5%) in 2007-2008 (P?Conclusions and relevanceIn a series of cross-sectional surveys weighted to be representative of the adult US population, the prevalence of controlled BP increased between 1999-2000 and 2007-2008, did not significantly change from 2007-2008 through 2013-2014, and then decreased after 2013-2014.

SUBMITTER: Muntner P

PROVIDER: S-EPMC7489367 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Trends in Blood Pressure Control Among US Adults With Hypertension, 1999-2000 to 2017-2018.

Muntner Paul P Hardy Shakia T ST Fine Lawrence J LJ Jaeger Byron C BC Wozniak Gregory G Levitan Emily B EB Colantonio Lisandro D LD

JAMA 20200901 12

<h4>Importance</h4>Controlling blood pressure (BP) reduces the risk for cardiovascular disease.<h4>Objective</h4>To determine whether BP control among US adults with hypertension changed from 1999-2000 through 2017-2018.<h4>Design, setting, and participants</h4>Serial cross-sectional analysis of National Health and Nutrition Examination Survey data, weighted to be representative of US adults, between 1999-2000 and 2017-2018 (10 cycles), including 18 262 US adults aged 18 years or older with hype ...[more]

PMID: 32902588

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Project description:ImportanceHigher blood pressure (BP) levels in children are associated with an increased risk for hypertension and subclinical cardiovascular disease in adulthood. Identifying trends in BP could inform the need for interventions to lower BP.ObjectiveTo determine whether systolic BP (SBP) and diastolic BP (DBP) levels among US children have changed during the past 20 years.Design, setting, and participantsThis serial cross-sectional analysis of National Health and Nutrition Examination Survey data included 9117 children aged 8 to 12 years and 10 156 adolescents aged 13 to 17 years, weighted to the US population from 1999-2002 to 2015-2018. Data were collected from March 1999 to December 2018 and analyzed from March 26, 2020, to February 2, 2021.ExposuresCalendar year.Main outcomes and measuresThe primary outcomes were mean SBP and mean DBP.ResultsA total of 19 273 participants were included in the analysis. Among children aged 8 to 12 years in 2015-2018 (mean age, 10.5 [95% CI, 10.5-10.6] years), 48.7% (95% CI, 45.2%-52.2%) were girls and 51.3% (95% CI, 47.8%-54.8%) were boys; 49.7% (95% CI, 42.2%-57.1%) were non-Hispanic White; 13.7% (95% CI, 10.3%-18.1%) were non-Hispanic Black; 25.5% (95% CI, 19.9%-32.0%) were Hispanic; 4.7% (95% CI, 3.2%-6.7%) were non-Hispanic Asian; and 6.5% (95% CI, 4.9%-8.5%) were other non-Hispanic race/ethnicity. Among those aged 13 to 17 years in 2015-2018 (mean age, 15.5 [95% CI, 15.5-15.5] years), 49.1% (95% CI, 46.1%-52.2%) were girls and 50.9% (95% CI, 47.8%-53.9%) were boys; 53.3% (95% CI, 46.4%-60.1%) were non-Hispanic White; 13.9% (95% CI, 10.3%-18.7%) were non-Hispanic Black; 21.9% (95% CI, 16.6%-28.2%) were Hispanic; 4.6% (95% CI, 3.2%-6.5%) were non-Hispanic Asian; and 6.3% (95% CI, 4.7%-8.5%) were other non-Hispanic race/ethnicity. Among children aged 8 to 12 years, age-adjusted mean SBP decreased from 102.4 (95% CI, 101.7-103.1) mm Hg in 1999-2002 to 101.5 (95% CI, 100.8-102.2) mm Hg in 2011-2014 and then increased to 102.5 (95% CI, 101.9-103.2) mm Hg in 2015-2018. Age-adjusted mean DBP decreased from 57.2 (95% CI, 56.5-58.0) mm Hg in 1999-2002 to 51.9 (95% CI, 50.1-53.7) mm Hg in 2011-2014 and increased to 53.2 (95% CI, 52.2-54.1) mm Hg in 2015-2018. Among adolescents aged 13 to 17 years, age-adjusted mean SBP decreased from 109.2 (95% CI, 108.7-109.7) mm Hg in 1999-2002 to 108.4 (95% CI, 107.8-109.1) mm Hg in 2011-2014 and remained unchanged in 2015-2018 (108.4 [95% CI, 107.8-109.1] mm Hg). Mean DBP decreased from 62.6 (95% CI, 61.7-63.5) mm Hg in 1999-2002 to 59.6 (95% CI, 58.2-60.9) mm Hg in 2011-2014 and then increased to 60.8 (95% CI, 59.8-61.7) mm Hg in 2015-2018. Among children aged 8 to 12 years, mean SBP was 3.2 (95% CI, 1.7-4.6) mm Hg higher among those with overweight and 6.8 (95% CI, 5.6-8.1) mm Hg higher among those with obesity compared with normal weight; mean DBP was 3.2 (95% CI, 0.7-5.6) mm Hg higher among those with overweight and 3.5 (95% CI, 1.9- 5.1) mm Hg higher among those with obesity compared with normal weight. Among adolescents aged 13 to 17 years, mean SBP was 3.5 (95% CI 1.9-5.1) mm Hg higher among those with overweight and 6.6 (95% CI, 5.2-8.0) mm Hg higher among those with obesity compared with normal weight, 4.8 (95% CI, 3.8-5.8) mm Hg higher among boys compared with girls, and 3.0 (95% CI, 1.7-4.3) mm Hg higher among non-Hispanic Black compared with non-Hispanic White participants.Conclusions and relevanceDespite an overall decline in mean SBP and DBP from 1999-2002 to 2015-2018, BP levels among children and adolescents may have increased from 2011-2014 to 2015-2018.

Project description:BackgroundDocumenting current trends in diabetes treatment and risk-factor control may inform public health policy and planning.MethodsWe conducted a cross-sectional analysis of data from adults with diabetes in the United States participating in the National Health and Nutrition Examination Survey (NHANES) to assess national trends in diabetes treatment and risk-factor control from 1999 through 2018.ResultsDiabetes control improved from 1999 to the early 2010s among the participants but subsequently stalled and declined. Between the 2007-2010 period and the 2015-2018 period, the percentage of adult NHANES participants with diabetes in whom glycemic control (glycated hemoglobin level, <7%) was achieved declined from 57.4% (95% confidence interval [CI], 52.9 to 61.8) to 50.5% (95% CI, 45.8 to 55.3). After major improvements in lipid control (non-high-density lipoprotein cholesterol level, <130 mg per deciliter) in the early 2000s, minimal improvement was seen from 2007-2010 (52.3%; 95% CI, 49.2 to 55.3) to 2015-2018 (55.7%; 95% CI, 50.8 to 60.5). From 2011-2014 to 2015-2018, the percentage of participants in whom blood-pressure control (<140/90 mm Hg) was achieved decreased from 74.2% (95% CI, 70.7 to 77.4) to 70.4% (95% CI, 66.7 to 73.8). The percentage of participants in whom all three targets were simultaneously achieved plateaued after 2010 and was 22.2% (95% CI, 17.9 to 27.3) in 2015-2018. The percentages of participants who used any glucose-lowering medication or any blood-pressure-lowering medication were unchanged after 2010, and the percentage who used statins plateaued after 2014. After 2010, the use of combination therapy declined in participants with uncontrolled blood pressure and plateaued for those with poor glycemic control.ConclusionsAfter more than a decade of progress from 1999 to the early 2010s, glycemic and blood-pressure control declined in adult NHANES participants with diabetes, while lipid control leveled off. (Funded by the National Heart, Lung, and Blood Institute.).

Project description:ImportanceUnderstanding population-wide trends in prevalence and control of diabetes is critical to planning public health approaches for prevention and management of the disease.ObjectiveTo determine trends in prevalence of diabetes and control of risk factors in diabetes among US adults between 1999-2000 and 2017-2018.Design, setting, and participantsTen cycles of cross-sectional National Health and Nutrition Examination Survey (NHANES) data between 1999-2000 and 2017-2018 were included. The study samples were weighted to be representative of the noninstitutionalized civilian resident US population. Adults aged 18 years or older were included, except pregnant women.ExposuresSurvey cycle.Main outcomes and measuresDiabetes was defined by self-report of diabetes diagnosis, fasting plasma glucose level of 126 mg/dL or more, or hemoglobin A1c (HbA1c) level of 6.5% or more. Three risk factor control goals were individualized HbA1c targets, blood pressure less than 130/80 mm Hg, and low-density lipoprotein cholesterol level less than 100 mg/dL. Prevalence of diabetes and proportion of adults with diagnosed diabetes who achieved risk factor control goals, overall and by sociodemographic variables, were estimated.ResultsAmong the 28 143 participants included (weighted mean age, 48.2 years; 49.3% men), the estimated age-standardized prevalence of diabetes increased significantly from 9.8% (95% CI, 8.6%-11.1%) in 1999-2000 to 14.3% (95% CI, 12.9%-15.8%) in 2017-2018 (P for trend < .001). From 1999-2002 to 2015-2018, the estimated age-standardized proportion of adults with diagnosed diabetes who achieved blood pressure less than 130/80 mm Hg (P for trend = .007) and low-density lipoprotein cholesterol level less than 100 mg/dL (P for trend < .001) increased significantly, but not individualized HbA1c targets (P for trend = .51). In 2015-2018, 66.8% (95% CI, 63.2%-70.4%), 48.2% (95% CI, 44.6%-51.8%), and 59.7% (95% CI, 54.2%-65.2%) of adults with diagnosed diabetes achieved individualized HbA1c targets, blood pressure less than 130/80 mm Hg, and low-density lipoprotein cholesterol level less than 100 mg/dL, respectively. Only 21.2% of these adults (95% CI, 15.5%-26.8%) achieved all 3. During the entire study period, these 3 goals were significantly less likely to be achieved among young adults aged 18 to 44 years (vs older adults ≥65 years: estimated proportion, 7.4% vs 21.7%; adjusted odds ratio, 0.32 [95% CI, 0.16-0.63]), non-Hispanic Black adults (vs non-Hispanic White adults: estimated age-standardized proportion, 12.5% vs 20.6%; adjusted odds ratio, 0.60 [95% CI, 0.40-0.90]), and Mexican American adults (vs non-Hispanic White adults: estimated age-standardized proportion, 10.9% vs 20.6%; adjusted odds ratio, 0.48 [95% CI, 0.31-0.77]).Conclusions and relevanceBased on NHANES data from US adults, the estimated prevalence of diabetes increased significantly between 1999-2000 and 2017-2018. Only an estimated 21% of adults with diagnosed diabetes achieved all 3 risk factor control goals in 2015-2018.

Project description:ObjectivesTrends in prevalence and treatments of atherosclerotic cardiovascular disease (ASCVD) remains to be documented, with frequent update of relevant guidelines. We aimed to characterize trends in prevalence of ASCVD, and risk factor control and medications among ASCVD adults.MethodsWe conducted a cross-sectional analysis of data from 55,081 adults in the National Health and Nutrition Examination Surveys (NHANES) 1999-2018.ResultsThe age-standardized prevalence of ASCVD did not change significantly from 1999-2002 (7.9 %, 95 % CI 7.1 %-8.7 %) to 2015-2018 (7.5 %, CI 6.8 %-8.3 %) (P for trend =0.18), representing an estimated 19.9 million individuals with ASCVD in 2015-2018. The prevalence of premature ASCVD was 2.0 % (CI, 1.6 %-2.5 %). Over 60.0 % of ASCVD participants were at very-high risk. From 1999-2002 to 2015-2018, the percentage with lipid control (non-high-density lipoprotein cholesterol <100 mg/dL) increased from 7.0 % (CI, 3.5 %-12.3 %) to 26.4 % (CI, 16.2 %-38.9 %). The percentage with blood-pressure control (<130/80 mmHg) increased from 51.2 % (CI, 41.0 %-61.3 %) in 1999-2002 to 57.2 % (CI, 48.4 %-65.6 %) in 2011-2014, but then declined to 52.8 % (CI, 44.4 %-81.3 %) in 2015-2018. The percentage with glycemic control (HbA1c <7.0 %) decreased from 95.0 % (CI, 90.2 %-97.9 %) to 84.0 % (CI, 75.9 %-90.3 %). The percentage who achieved all 3 targets was 18.6 % (CI, 8.2 %-33.8 %) in 2015-2018. The percentage of ASCVD participants who were taking statins increased from 1999-2002 to 2011-2014, but then leveled off. Approximately 60 % of individuals with ASCVD and less than 40 % of those with premature ASCVD were taking statins in 2015-2018. The utilization of blood-pressure-lowering drugs remained largely constant over time, whereas the use of glucose-lowering drugs increased.ConclusionsBased on NHANES data from US adults, the estimated prevalence of ASCVD remained relatively stable between 1999 and 2018. Substantial undertreatment with stains was found in individuals with ASCVD, and the percentage achieving optimal lipid control was low.

Dataset Information

Trends in Blood Pressure Control Among US Adults With Hypertension, 1999-2000 to 2017-2018.

Importance

Objective

Design, setting, and participants

Exposures

Main outcomes and measures

Results

Publications

Trends in Blood Pressure Control Among US Adults With Hypertension, 1999-2000 to 2017-2018.

Similar Datasets

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