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      Blood Pressure Control Among US Adults, 2009 to 2012 Through 2017 to 2020

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          Abstract

          Background:

          The National Health and Nutrition Examination Survey data indicate that the proportion of US adults with hypertension that had controlled blood pressure (BP) declined from 2013 to 2014 through 2017 to 2018. We analyzed data from National Health and Nutrition Examination Survey 2009 to 2012, 2013 to 2016, and 2017 to 2020 to confirm this finding.

          Methods:

          Hypertension was defined as systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg or antihypertensive medication use. BP control among those with hypertension was defined as systolic BP <140 mm Hg and diastolic BP <90 mm Hg.

          Results:

          The age-adjusted prevalence of hypertension was 31.5% (95% CI, 30.3%–32.8%), 32.0% (95% CI, 30.6%–33.3%), and 32.9% (95% CI, 31.0%–34.7%) in 2009 to 2012, 2013 to 2016, and 2017 to 2020, respectively ( P trend=0.218). The age-adjusted prevalence of hypertension increased among non-Hispanic Asian adults from 27.0% in 2011 to 2012 to 33.5% in 2017 to 2020 ( P trend=0.003). Among Hispanic adults, the age-adjusted prevalence of hypertension increased from 29.4% in 2009 to 2012 to 33.2% in 2017 to 2020 ( P trend=0.029). In 2009 to 2012, 2013 to 2016, and 2017 to 2020, 52.8% (95% CI, 50.0%–55.7%), 51.3% (95% CI, 47.9%–54.6%), and 48.2% (95% CI, 45.7%–50.8%) of US adults with hypertension had controlled BP ( P trend=0.034). Among US adults taking antihypertensive medication, 69.9% (95% CI, 67.8%–72.0%), 69.3% (95% CI, 66.6%–71.9%), and 67.7% (95% CI, 65.2%–70.3%) had controlled BP in 2009 to 2012, 2013 to 2016, and 2017 to 2020, respectively ( P trend=0.189). Among all US adults with hypertension and those taking antihypertensive medication, a decline in BP control between 2009 to 2012 and 2017 to 2020 occurred among those ≥75 years, women, and non-Hispanic black adults.

          Conclusions:

          These data confirm that the proportion of US adults with hypertension who have controlled BP has declined.

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          Most cited references41

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          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

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            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).

            Hypertension is the most common condition seen in primary care and leads to myocardial infarction, stroke, renal failure, and death if not detected early and treated appropriately. Patients want to be assured that blood pressure (BP) treatment will reduce their disease burden, while clinicians want guidance on hypertension management using the best scientific evidence. This report takes a rigorous, evidence-based approach to recommend treatment thresholds, goals, and medications in the management of hypertension in adults. Evidence was drawn from randomized controlled trials, which represent the gold standard for determining efficacy and effectiveness. Evidence quality and recommendations were graded based on their effect on important outcomes. There is strong evidence to support treating hypertensive persons aged 60 years or older to a BP goal of less than 150/90 mm Hg and hypertensive persons 30 through 59 years of age to a diastolic goal of less than 90 mm Hg; however, there is insufficient evidence in hypertensive persons younger than 60 years for a systolic goal, or in those younger than 30 years for a diastolic goal, so the panel recommends a BP of less than 140/90 mm Hg for those groups based on expert opinion. The same thresholds and goals are recommended for hypertensive adults with diabetes or nondiabetic chronic kidney disease (CKD) as for the general hypertensive population younger than 60 years. There is moderate evidence to support initiating drug treatment with an angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, calcium channel blocker, or thiazide-type diuretic in the nonblack hypertensive population, including those with diabetes. In the black hypertensive population, including those with diabetes, a calcium channel blocker or thiazide-type diuretic is recommended as initial therapy. There is moderate evidence to support initial or add-on antihypertensive therapy with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in persons with CKD to improve kidney outcomes. Although this guideline provides evidence-based recommendations for the management of high BP and should meet the clinical needs of most patients, these recommendations are not a substitute for clinical judgment, and decisions about care must carefully consider and incorporate the clinical characteristics and circumstances of each individual patient.
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              Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.

              The National High Blood Pressure Education Program presents the complete Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Like its predecessors, the purpose is to provide an evidence-based approach to the prevention and management of hypertension. The key messages of this report are these: in those older than age 50, systolic blood pressure (BP) of greater than 140 mm Hg is a more important cardiovascular disease (CVD) risk factor than diastolic BP; beginning at 115/75 mm Hg, CVD risk doubles for each increment of 20/10 mm Hg; those who are normotensive at 55 years of age will have a 90% lifetime risk of developing hypertension; prehypertensive individuals (systolic BP 120-139 mm Hg or diastolic BP 80-89 mm Hg) require health-promoting lifestyle modifications to prevent the progressive rise in blood pressure and CVD; for uncomplicated hypertension, thiazide diuretic should be used in drug treatment for most, either alone or combined with drugs from other classes; this report delineates specific high-risk conditions that are compelling indications for the use of other antihypertensive drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, calcium channel blockers); two or more antihypertensive medications will be required to achieve goal BP (<140/90 mm Hg, or <130/80 mm Hg) for patients with diabetes and chronic kidney disease; for patients whose BP is more than 20 mm Hg above the systolic BP goal or more than 10 mm Hg above the diastolic BP goal, initiation of therapy using two agents, one of which usually will be a thiazide diuretic, should be considered; regardless of therapy or care, hypertension will be controlled only if patients are motivated to stay on their treatment plan. Positive experiences, trust in the clinician, and empathy improve patient motivation and satisfaction. This report serves as a guide, and the committee continues to recognize that the responsible physician's judgment remains paramount.
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                Author and article information

                Journal
                Hypertension
                Hypertension
                HYP
                Hypertension (Dallas, Tex. : 1979)
                Lippincott Williams & Wilkins (Hagerstown, MD )
                0194-911X
                1524-4563
                26 May 2022
                September 2022
                26 May 2022
                : 79
                : 9
                : 1971-1980
                Affiliations
                [1]Department of Epidemiology (P.M., S.T.H.), University of Alabama at Birmingham.
                [2]Department of Health Behavior (M.A.M., L.H.), University of Alabama at Birmingham.
                [3]Department of Biostatistics, Wake Forest University School of Medicine, Winston Salem, NC (B.C.J.).
                [4]School of Nursing, Johns Hopkins University, Baltimore, MD (Y.O.).
                [5]American Medical Association, Chicago, IL (G.W.).
                [6]Department of Medicine, Columbia University Irving Medical Center, New York, NY (J.E.S.).
                [7]Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook, NY (J.E.S.).
                Author notes
                Correspondence to: Paul Muntner, Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1665 University Blvd, Suite 140J, Birmingham, AL 35294. Email pmuntner@ 123456uab.edu
                Article
                00008
                10.1161/HYPERTENSIONAHA.122.19222
                9370255
                35616029
                dde4a8f3-6aeb-409c-8a3b-7c4fcf852861
                © 2022 American Heart Association, Inc.

                This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

                History
                : 17 February 2022
                : 9 May 2022
                Categories
                10062
                Original Articles
                Custom metadata
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                blood pressure,epidemiology,female,hypertension,prevalence
                blood pressure, epidemiology, female, hypertension, prevalence

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