Advertisement

The National Health and Nutrition Examination Survey III

How Are We Doing with Blood Pressure Control?
  • David A. Calhoun
  • Suzanne Oparil
Chapter
Part of the Current Clinical Practice book series (CCP)

Abstract

Untreated and uncontrolled hypertension is a major health problem in the United States. Findings from the Third National Health and Nutrition Examination Survey (NHANES III, phase 2), conducted from 1991 to 1994, indicate that this problem may be worsening (Fig. 32-1) (1). Major decreases in awareness, treatment, and control rates for hypertension have been recorded in the past decade despite extensive educational programs directed toward patients and health care providers, the widespread availability of facilities for diagnosis and treatment, and the development of effective management strategies (2–4). Because of the high prevalence of hypertension in the United States, the observed decline in control rates is estimated to put more than 1 million hypertensive patients at increased risk for target organ damage (TOD) and cardiovascular disease—related morbidity and mortality. Although a causal relationship has not been established, the decline in hypertension detection, treatment, and control rates has coincided with an increase in morbidity and mortality owing to cardiovascular disease (Fig. 322) (5). Since 1993, age-adjusted stroke rates have risen, the slope of the age-adjusted rate of decline in coronary heart disease has leveled off, and the incidence of end-stage renal disease and the prevalence of heart failure have increased. These trends support an urgent need for greater emphasis on public awareness of the problem of high blood pressure (BP) and on more aggressive approaches to antihypertensive treatment and BP control by caregivers.

Keywords

Antihypertensive Drug Antihypertensive Treatment Usual Care Group Target Organ Damage Improve Blood Pressure Control 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Burt VL, Whelton P, Roccella EJ, et al. (1995) Prevalence of hypertension in the US adult population: results from the Third National Health and Nutrition Examination Survey, 1988–1991. Hypertension 25: 305–313.PubMedCrossRefGoogle Scholar
  2. 2.
    Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (1997) The sixth report of the Joint National Committee on the Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med 157: 24132446.Google Scholar
  3. 3.
    Brown RD Jr, Whisnant JP, Sicks JD, et al. (1996) Stroke incidence, prevalence, and survival: secular trends in Rochester, Minnesota, through 1989. Stroke 27: 373380.Google Scholar
  4. 4.
    Glynn RJ, Brock DB, Harris T, et al. (1995) Use of antihypertensive drugs and trends in blood pressure in the elderly. Arch Intern Med 155: 1855–1860.PubMedCrossRefGoogle Scholar
  5. 5.
    Heart and Stroke Facts (1997) 1998 Statistical Supplement, American Heart Association.Google Scholar
  6. 6.
    Prisant LM, Alpert BS, Robbins CB, et al. (1995) American National Standard for nonautomated sphygmomanometers: summary report. Am J Hypertens 8: 210–213.PubMedCrossRefGoogle Scholar
  7. 7.
    Perloff D, Grim C, Flack J, et al., for the Writing Group (1993) Human blood pressure determination by sphygmomanometry. Circulation 88: 2460–2467.Google Scholar
  8. 8.
    Haynes RB, Mattson ME, Chobanian AV, et al. (1982) Management of patient compliance in the treatment of hypertension: report of the NHLBI Working Group. Hypertension 4: 415–423.CrossRefGoogle Scholar
  9. 9.
    Jones JK, Gorkin L, Lian LF, et al. (1995) Discontinuation of and changes in treatment after start of new courses of antihypertensive drugs: a study of a United Kingdom population. BMJ 311: 293–295.PubMedCrossRefGoogle Scholar
  10. 10.
    Caro JJ, Jackson J, Speckman J, et al. (1997) Compliance as a function of initial choice of antihypertensive drug. Am J Hypertens 10: 141A (abstract).Google Scholar
  11. 11.
    Moore MA, Gazdick LP, Edelman JM, et al. (1998) Losartan effectiveness and tolerability (LET) study. Am J Hypertens 11: 104A (abstract).Google Scholar
  12. 12.
    Elliott WJ (1995) Costs associated with changing antihypertensive drug monotherapy: “preferred” vs. “alternative” therapy. Am J Hypertens 8: 80A (abstract).Google Scholar
  13. 13.
    Miller NH, Hill M, Kottke T, Ockene IS (1997) The multilevel compliance challenge: recommendations for a call to action. A statement for healthcare professionals. AHA special report. Circulation 95: 1085–1090.PubMedCrossRefGoogle Scholar
  14. 14.
    Hill NM (1999) Adherence to antihypertensive therapy. In: Hypertens Primer, 2nd ed., pp. 348–351.Google Scholar
  15. 15.
    Oparil S, Calhoun DA (1998) Managing the patient with hard-to-control hypertension. Am Fam Physician 57: 1007–1014.PubMedGoogle Scholar
  16. 16.
    Setaro JF, Black HR (1992) Refractory hypertension. N Engl J Med 327: 543–547.PubMedCrossRefGoogle Scholar
  17. 17.
    Hansson L, Zanchetti A, Carruthers SG, et al., for the HOT Study Group (1998) Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomized trial. Lancet 351: 1755–1762.Google Scholar
  18. 18.
    Neaton JD, Grimm RH Jr, Prineas RJ, et al. (1993) Treatment of Mild Hypertension Study: Final Results. Treatment of Mild Hypertension Study Research Group. JAMA 270: 713–724.PubMedCrossRefGoogle Scholar
  19. 19.
    Sica DA (1994) Fixed-dose combination antihypertensive drugs: do they have a role in rational therapy? Drugs 48: 16–24.PubMedCrossRefGoogle Scholar
  20. 20.
    National High Blood Pressure Education Program Working Group report on hypertension and chronic renal failure (1991) Arch Intern Med 151: 1280–1287.Google Scholar
  21. 21.
    Turner R, Holman R, Stratton I, et al. (1998) UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ 317: 703–713.CrossRefGoogle Scholar
  22. 22.
    Holman R, Turner R, Stratton I, et al. (1998) Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. BMJ 317: 713–720.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2001

Authors and Affiliations

  • David A. Calhoun
  • Suzanne Oparil

There are no affiliations available

Personalised recommendations