Trends in Blood Pressure Control Among US Adults With Hypertension, 1999-2000 to 2017-2018
Trends in Blood Pressure Control Among US Adults With Hypertension, 1999-2000 to 2017-2018
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DOI：
10.1001/jama.2020.14545
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发表时间：
2020-09-09
影响因子：
120.7
通讯作者：
Colantonio, Lisandro D.
中科院分区：
文献类型：
--
作者：
Muntner, Paul;Hardy, Shakia T.;Colantonio, Lisandro D.
重要性：控制血压（BP）可降低心血管疾病风险。
目的：确定1999 - 2000年至2017 - 2018年期间美国高血压成年人的血压控制情况是否发生变化。
设计、地点和参与者：对1999 - 2000年至2017 - 2018年（10个周期）的美国国家健康与营养检查调查数据进行系列横断面分析，数据经加权后可代表美国成年人，包括18262名18岁及以上患有高血压的美国成年人，高血压定义为收缩压水平为140 mmHg或更高、舒张压水平为90 mmHg或更高，或使用抗高血压药物。最终数据收集日期为2018年。
暴露因素：日历年。
主要结果和测量指标：平均血压通过3次测量计算得出。血压控制的主要结果定义为收缩压水平低于140 mmHg且舒张压水平低于90 mmHg。
结果：在此项分析纳入的51761名参与者中，平均（标准差）年龄为48（19）岁，25939人（50.1%）为女性；43.2%为非西班牙裔白人成年人；21.6%为非西班牙裔黑人成年人；5.3%为非西班牙裔亚洲成年人；26.1%为西班牙裔成年人。在18262名高血压成年人中，年龄调整后的血压控制估计比例从1999 - 2000年的31.8%（95%置信区间，26.9% - 36.7%）增加到2007 - 2008年的48.5%（95%置信区间，45.5% - 51.5%）（趋势P <.001），在2013 - 2014年保持稳定，为53.8%（95%置信区间，48.7% - 59.0%）（趋势P =.14），然后在2017 - 2018年下降到43.7%（95%置信区间，40.2% - 47.2%）（趋势P =.003）。与18岁至44岁的成年人相比，估计45岁至64岁的人更有可能控制血压（49.7%对36.7%；多变量调整后的患病率比值为1.18 [95%置信区间，1.02 - 1.37]），而75岁及以上的人控制血压的可能性较小（37.3%对36.7%；多变量调整后的患病率比值为0.81 [95%置信区间，0.65 - 0.97]）。估计非西班牙裔黑人成年人与非西班牙裔白人成年人相比控制血压的可能性较小（分别为41.5%对48.2%；多变量调整后的患病率比值为0.88；95%置信区间，0.81 - 0.96）。有私人保险（48.2%）、医疗保险（53.4%）或除医疗保险和医疗补助之外的政府健康保险（43.2%）的人比没有健康保险的人更有可能控制血压（24.2%）（多变量调整后的患病率比值分别为1.40 [95%置信区间，1.08 - 1.80]、1.47 [95%置信区间，1.15 - 1.89]和1.36 [95%置信区间，1.04 - 1.76]）。有常规医疗保健机构的人比没有的人更有可能控制血压（分别为48.4%对26.5%；多变量调整后的患病率比值为1.48 [95%置信区间，1.13 - 1.94]），过去一年有医疗保健就诊的人比没有的人更有可能控制血压（分别为49.1%对8.0%；多变量调整后的患病率比值为5.23 [95%置信区间，2.88 - 9.49]）。
结论和相关性：在一系列经加权后可代表美国成年人口的横断面调查中，血压控制的患病率在1999 - 2000年至2007 - 2008年期间增加，在2007 - 2008年至2013 - 2014年期间没有显著变化，然后在2013 - 2014年之后下降。
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 < .001 for trend), remained stable and was 53.8% (95% CI, 48.7%-59.0%) in 2013-2014 (P = .14 for trend), and then declined to 43.7% (95% CI, 40.2%-47.2%) in 2017-2018 (P = .003 for trend). Compared with adults who were aged 18 years to 44 years, it was estimated that controlled BP was more likely among those aged 45 years to 64 years (49.7% vs 36.7%; multivariable-adjusted prevalence ratio, 1.18 [95% CI, 1.02-1.37]) and less likely among those aged 75 years or older (37.3% vs 36.7%; multivariable-adjusted prevalence ratio, 0.81 [95% CI, 0.65-0.97]). It was estimated that controlled BP was less likely among non-Hispanic Black adults vs non-Hispanic White adults (41.5% vs 48.2%, respectively; multivariable-adjusted prevalence ratio, 0.88; 95% CI, 0.81-0.96). Controlled BP was more likely among those with private insurance (48.2%), Medicare (53.4%), or government health insurance other than Medicare or Medicaid (43.2%) vs among those without health insurance (24.2%) (multivariable-adjusted prevalence ratio, 1.40 [95% CI, 1.08-1.80], 1.47 [95% CI, 1.15-1.89], and 1.36 [95% CI, 1.04-1.76], respectively). Controlled BP was more likely among those with vs those without a usual health care facility (48.4% vs 26.5%, respectively; multivariable-adjusted prevalence ratio, 1.48 [95% CI, 1.13-1.94]) and among those who had vs those who had not had a health care visit in the past year (49.1% vs 8.0%; multivariable-adjusted prevalence ratio, 5.23 [95% CI, 2.88-9.49]).CONCLUSIONS AND RELEVANCE: In 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.