Hajjar Ihab, Kotchen Theodore A
Division of Geriatrics, Department of Medicine, Palmetto Health Richland, University of South Carolina, Columbia, USA.
JAMA. 2003 Jul 9;290(2):199-206. doi: 10.1001/jama.290.2.199.
Prior analyses of National Health and Nutrition Examination Survey (NHANES) data through 1991 have suggested that hypertension prevalence is declining, but more recent self-reported rates of hypertension suggest that the rate is increasing.
To describe trends in the prevalence, awareness, treatment, and control of hypertension in the United States using NHANES data.
DESIGN, SETTING, AND PARTICIPANTS: Survey using a stratified multistage probability sample of the civilian noninstitutionalized population. The most recent NHANES survey, conducted in 1999-2000 (n = 5448), was compared with the 2 phases of NHANES III conducted in 1988-1991 (n = 9901) and 1991-1994 (n = 9717). Individuals aged 18 years or older were included in this analysis.
Hypertension, defined as a measured blood pressure of 140/90 mm Hg or greater or reported use of antihypertensive medications. Hypertension awareness and treatment were assessed with standardized questions. Hypertension control was defined as treatment with antihypertensive medication and a measured blood pressure of less than 140/90 mm Hg.
In 1999-2000, 28.7% of NHANES participants had hypertension, an increase of 3.7% (95% confidence interval [CI], 0%-8.3%) from 1988-1991. Hypertension prevalence was highest in non-Hispanic blacks (33.5%), increased with age (65.4% among those aged > or =60 years), and tended to be higher in women (30.1%). In a multiple regression analysis, increasing age, increasing body mass index, and non-Hispanic black race/ethnicity were independently associated with increased rates of hypertension. Overall, in 1999-2000, 68.9% were aware of their hypertension (nonsignificant decline of -0.3%; 95% CI, -4.2% to 3.6%), 58.4% were treated (increase of 6.0%; 95% CI, 1.2%-10.8%), and hypertension was controlled in 31.0% (increase of 6.4%; 95% CI, 1.6%-11.2%). Women, Mexican Americans, and those aged 60 years or older had significantly lower rates of control compared with men, younger individuals, and non-Hispanic whites.
Contrary to earlier reports, hypertension prevalence is increasing in the United States. Hypertension control rates, although improving, continue to be low. Programs targeting hypertension prevention and treatment are of utmost importance.
对1991年以前的美国国家健康与营养检查调查（NHANES）数据进行的分析表明，高血压患病率正在下降，但最近自我报告的高血压患病率却显示该患病率正在上升。
利用NHANES数据描述美国高血压患病率、知晓率、治疗率及控制率的趋势。
设计、地点和参与者：采用分层多阶段概率抽样对非机构化平民人口进行调查。将1999 - 2000年进行的最新NHANES调查（n = 5448）与1988 - 1991年（n = 9901）和1991 - 1994年（n = 9717）进行的NHANES III的两个阶段进行比较。纳入分析的对象为18岁及以上的个体。
高血压定义为测量血压为140/90 mmHg或更高，或报告使用抗高血压药物。通过标准化问题评估高血压知晓率和治疗率。高血压控制定义为使用抗高血压药物治疗且测量血压低于140/90 mmHg。
在1999 - 2000年，NHANES参与者中有28.7%患有高血压，比1988 - 1991年增加了3.7%（95%置信区间[CI]，0% - 8.3%）。非西班牙裔黑人的高血压患病率最高（33.5%），随年龄增长而增加（60岁及以上者中为65.4%），女性患病率往往更高（30.1%）。在多元回归分析中，年龄增加、体重指数增加以及非西班牙裔黑人种族/族裔与高血压患病率增加独立相关。总体而言，在1999 - 2000年，68.9%的人知晓自己患有高血压（无显著下降，下降0.3%；95% CI， - 4.2%至3.6%），58.4%的人接受了治疗（增加6.0%；95% CI，1.2% - 10.8%），31.0%的高血压得到控制（增加6.4%；95% CI，1.6% - 11.2%）。与男性、年轻人和非西班牙裔白人相比，女性、墨西哥裔美国人以及60岁及以上的人控制率显著较低。
与早期报告相反，美国高血压患病率正在上升。高血压控制率虽在提高，但仍然较低。针对高血压预防和治疗的项目至关重要。
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