Hypertension in the United States, 1999 to 2012: progress toward Healthy People 2020 goals.
Hypertension in the United States, 1999 to 2012: progress toward Healthy People 2020 goals.
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DOI：
10.1161/circulationaha.114.010676
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发表时间：
2014-11-04
期刊：
影响因子：
37.8
通讯作者：
Ferdinand KC
中科院分区：
文献类型：
--
作者：
Egan BM;Li J;Hutchison FN;Ferdinand KC
为了减少心血管疾病的负担，2020年健康人群为美国成年人制定了高血压目标：（1）将患病率降至26.9%。(2)将处理提高到69.5%，防治提高到61.2%，处理需防治88.1%。为了评估这些“健康人2020”目标的当前状况和进展，对1999-2012年国家健康与营养检查调查数据中两年期的时间趋势进行了评估，对象为年龄调整至美国2010年的≥18岁成年人。从1999-2000年至2011-2012年，高血压患病率保持不变（30.1% vs. 30.8%，p=0.32）。高血压治疗（59.8% vs. 74.7%，p<0.001）和接受治疗的成人控制比例（53.3%至68.9%，p=0.0015）增加。从1999-2000年到2009-2010年，高血压控制到<140/<90 mmHg每两年上升一次（32.2%对53.8%，p<0.001），然后在2011-2012年下降到51.2%。在多变量逻辑回归模型中显著的可修改因素包括：（a）随着高血压患病而增加的体重指数（比值比[OR] 1.44）。(b)缺乏健康保险（OR 1.68）和未治疗的高血压患者每年<2次医疗保健就诊（OR 4.24）。(c)医疗保险（OR 1.69）、≥2次医疗访视/年（OR 3.23）和胆固醇治疗（OR 1.90）伴控制的高血压。NHANES 1999-2012分析表明，健康人群2020年高血压目标：（1）患病率显示无进展（2）治疗超过（3）控制水平低于目标。研究结果与以下证据一致：（a）肥胖预防和治疗可降低高血压患病率（B）医疗保险、≥2次医疗访视/年和基于指南的胆固醇治疗可改善高血压控制。
To reduce the cardiovascular disease burden, Healthy People 2020 established U.S. hypertension goals for adults to: (1) decrease prevalence to 26.9%. (2) raise treatment to 69.5% and control to 61.2%, which requires controlling 88.1% on treatment. To assess current status and progress toward these Healthy People 2020 goals, time trends in National Health and Nutrition Examination Surveys 1999–2012 data in twoyear blocks were assessed in adults ≥18 years old age-adjusted to U.S. 2010. From 1999–2000 to 2011–2012, prevalent hypertension was unchanged (30.1% vs. 30.8%, p=0.32). Hypertension treatment (59.8% vs. 74.7%, p<0.001) and proportion of treated adults controlled (53.3% to 68.9%, p=0.0015) increased. Hypertension control to <140/<90 mmHg rose every two years from 1999–2000 to 2009–2010 (32.2% vs. 53.8%, p<0.001) before declining to 51.2% in 2011–2012. Modifiable factor(s) significant in multivariable logistic regression modeling include: (a) increasing body mass index with prevalent hypertension (odds ratio [OR] 1.44). (b) lack of health insurance (OR 1.68) and <2 healthcare visits/year (OR 4.24) with untreated hypertension. (c) healthcare insurance (OR 1.69), ≥2 healthcare visits/year (OR 3.23) and cholesterol treatment (OR 1.90) with controlled hypertension. The NHANES 1999–2012 analysis suggests that Healthy People 2020 goals for hypertension: (1) prevalence show no progress (2) treatment was exceeded (3) control has flattened below target. Findings are consistent with evidence that: (a) obesity prevention and treatment could reduce prevalent hypertension (b) healthcare insurance, ≥2 healthcare visits/year, and guideline-based cholesterol treatment could improve hypertension control.