Trends and cardiovascular mortality effects of state-level blood pressure and uncontrolled hypertension in the United States
Trends and cardiovascular mortality effects of state-level blood pressure and uncontrolled hypertension in the United States
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DOI：
10.1161/circulationaha.107.732131
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发表时间：
2008-02-19
期刊：
影响因子：
37.8
通讯作者：
Murray, Christopher J. L.
中科院分区：
文献类型：
--
作者：
Ezzati, Majid;Oza, Shefali;Murray, Christopher J. L.
背景-血压是心血管疾病和死亡率的重要风险因素，其生活方式和医疗保健决定因素因州而异。在美国，只有自我报告的高血压状况是在州一级衡量的。我们的目的是评估州级平均收缩压(SBP)的水平和趋势，未控制的收缩压的患病率，以及可归因于所有水平的SBP高于最佳水平的心血管死亡率。方法和结果-我们在具有全国代表性的国家健康和营养检查调查中估计了实际SBP/未控制的高血压与自我报告的高血压、血压药物的使用以及一组健康系统和社会人口学变量的关系。我们将这种关系应用于行为危险因素监测系统中的相同变量，以估计特定州的平均SBP和未控制的高血压。我们使用比较风险评估方法来估计可归因于SBP高于最佳的心血管死亡率。2001-2003年，年龄标准化的未控制高血压患病率在哥伦比亚特区、密西西比州、路易斯安那州、阿拉巴马州、德克萨斯州、佐治亚州和南卡罗来纳州最高(男性为18%至21%，女性为24%至26%)，佛蒙特州、明尼苏达州、康涅狄格州、新罕布夏州、爱荷华州和科罗拉多州最低(男性为15%至16%，女性约为21%)。在每个州(亚利桑那州)到堪萨斯州(堪萨斯州)，女性的未控制高血压患病率都比男性高4到7个百分点。20世纪90年代，在爱达荷州和俄勒冈州，未得到控制的女性高血压增加最多(增加了6个百分点)，哥伦比亚特区和密西西比州最少(增加了3个百分点)。就男性而言，表现最差的州是新墨西哥州和路易斯安那州(分别下降0.6和1.3个百分点)，表现最好的州是佛蒙特州和印第安纳州(分别下降4和3个百分点)。女性的年龄标化心血管死亡率从200/10万(明尼苏达州和马萨诸塞州)到360到370/10万(哥伦比亚特区和密西西比州)，男性从210/10万(科罗拉多州和犹他州)到370/10万(密西西比州)和410/10万(哥伦比亚特区)。来自行为危险因素监测系统的自我报告的高血压诊断数据可用于获得对血压和未控制高血压的无偏见的州水平估计，作为优先设置以及设计和评估干预计划的基准。
Background-Blood pressure is an important risk factor for cardiovascular disease and mortality and has lifestyle and healthcare determinants that vary across states. Only self-reported hypertension status is measured at the state level in the United States. Our aim was to estimate levels and trends in state-level mean systolic blood pressure (SBP), the prevalence of uncontrolled systolic hypertension, and cardiovascular mortality attributable to all levels of higher-than-optimal SBP.Methods and Results-We estimated the relationship between actual SBP/uncontrolled hypertension and self-reported hypertension, use of blood pressure medication, and a set of health system and sociodemographic variables in the nationally representative National Health and Nutrition Examination Survey. We applied this relationship to identical variables from the Behavioral Risk Factor Surveillance System to estimate state-specific mean SBP and uncontrolled hypertension. We used the comparative risk assessment methods to estimate cardiovascular mortality attributable to higher-than-optimal SBP. In 2001-2003, age-standardized uncontrolled hypertension prevalence was highest in the District of Columbia, Mississippi, Louisiana, Alabama, Texas, Georgia, and South Carolina (18% to 21% for men and 24% to 26% for women) and lowest in Vermont, Minnesota, Connecticut, New Hampshire, Iowa, and Colorado (15% to 16% for men and approximate to 21% for women). Women had a higher prevalence of uncontrolled hypertension than men in every state by 4 (Arizona) to 7 (Kansas) percentage points. In the 1990s, uncontrolled hypertension in women increased the most in Idaho and Oregon (by 6 percentage points) and the least in the District of Columbia and Mississippi (by 3 percentage points). For men, the worst-performing states were New Mexico and Louisiana ( decrease of 0.6 and 1.3 percentage points), and the best-performing states were Vermont and Indiana (decrease of 4 and 3 percentage points). Age-standardized cardiovascular mortality attributable to higher-than-optimal SBP ranged from 200 to 220 per 100 000 (Minnesota and Massachusetts) to 360 to 370 per 100 000 (District of Columbia and Mississippi) for women and from 210 per 100 000 (Colorado and Utah) to 370 per 100 000 (Mississippi) and 410 per 100 000 (District of Columbia) for men.Conclusions-Lifestyle and pharmacological interventions for lowering blood pressure are particularly needed in the South and Appalachia, and with emphasis on control among women. Self-reported data on hypertension diagnosis from the Behavioral Risk Factor Surveillance System can be used to obtain unbiased state-level estimates of blood pressure and uncontrolled hypertension as benchmarks for priority setting and for designing and evaluating intervention programs.