The National Health and Nutrition Examination Survey III
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.
KeywordsAntihypertensive Drug Antihypertensive Treatment Usual Care Group Target Organ Damage Improve Blood Pressure Control
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