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

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.

Figure 1

The process is depicted for selecting adults 18–85 years old with hypertension from NHANES. Adults with hypertension were then subdivided by age <45, 45 – 64, and ≥65 years as shown.

Figure 2

The percentages are shown (mean and 95% confidence intervals) for hypertension prevalence, awareness, treatment, control and proportion of treated patients controlled (control/treated) among adults ≥18 years old in NHANES 1999–2012 at two-year increments. All trend lines showed a significant increase over time (p≤0.0015) except for prevalent hypertension (p=0.32).

Figure 3

The percentages are shown (mean and 95% confidence intervals) for hypertension prevalence, awareness, treatment, control and proportion of treated patients controlled (control/treated) among adults subdivided by age group (left: <45, 45 – 64, ≥65 years) and race/ethnicity (right: white, black, Hispanic) in NHANES 1999–2012 at two-year increments. Note p-values on the left are for over time trend and p-values on the right are for between group comparisons with p-values on the top panel for comparison between top and middle panel, on the middle panel for comparison between middle and bottom panel, on the bottom panel for comparison between top and bottom panel.