P1948Socioeconomic inequalities in the prevalence and management of hypertension: analyses of the Chilean National Health Surveys 2003, 2010 and 2017

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Passi ◽  
P Margozzini ◽  
J Mindell ◽  
M Ruiz ◽  
S Scholes
Keyword(s):  
Blood Pressure ◽  
National Health ◽  
Health Surveys ◽  
Universal Access ◽  
Hypertension Management ◽  
Hypertension Prevalence ◽  
Risk Of Death ◽  
Cardiovascular Morbidity And Mortality ◽  
And Control ◽  
National Health Surveys

Abstract Hypertension is the highest attributable risk of death worldwide, causing 7.1million deaths annually, and it is the primary cause of cardiovascular morbidity and mortality. In Chile, around one-in-three adults are living with this chronic health condition. Chilean evidence has shown inequalities in hypertension prevalence by various measures of socioeconomic position (SEP). However, information on SEP inequalities in the three key aspects of hypertension management (awareness, treatment, and control of high blood pressure), is only partially known. Purpose To assess SEP inequalities in hypertension prevalence and management in Chilean adults. Methods Data came from the Chilean National Health Surveys (ENS) 2003, 2010 and 2017. Years of formal education was used as the SEP measure. Age-and gender-specific Slope and Relative Indices of Inequalities (SII and RII) were calculated for the prevalence of hypertension (mean SBP ≥140mmHg, DBP ≥90mmHg, or current medication use to lower blood pressure) and for each management outcome. Results Analytical sample comprised 3,426; 4,838 and 5,373 participants aged ≥17y with blood pressure measurements for years 2003, 2010 and 2017, respectively. Prevalence of hypertension was 32.4%, 32.2% and 30.8% for the years 2003, 2010 and 2017, respectively. According to the SII and RII, males and females aged <65y showed higher hypertension prevalence among those with fewer years of education in 2003, 2010 and 2017. Among those classed as hypertensive, levels of awareness increased from 59.4% in 2003 to 65.9% in 2017. Over the same time period, levels of treatment increased from 39.0% to 65.2%, and levels of control increased from 14.1% to 23.9%. SEP inequalities in hypertension management – with better outcomes for the most educated – were highest among females aged ≥65y. Conclusion Introduction of universal access to care for hypertension in Chile in 2005 accounted partly for the rise of hypertension management levels since 2003. According to local and international strategies for the prevention and control of noncommunicable diseases, there is room for improvement. However, improvements should have a specific focus on SEP inequalities. Acknowledgement/Funding Chilean Ministry of Health

scholarly journals Hypertension care cascade in Chile: a serial cross-sectional study from national health surveys 2003-2010-2017.

2020 ◽  
Author(s):  
Alvaro Passi-Solar ◽  
Paula Margozzini ◽  
Jennifer S Mindell ◽  
Milagros A Ruiz ◽  
Carlos Valencia ◽  
...  
Keyword(s):  
National Health ◽  
Health Surveys ◽  
Antihypertensive Treatment ◽  
Universal Access ◽  
Cross Sectional ◽  
Hypertension Prevalence ◽  
Care Cascade ◽  
And Control ◽  
The Impact ◽  
National Health Surveys

Abstract Background: Data on trends in hypertension prevalence and indicators of attainment at each step of the care cascade are required in Chile. Aim : To quantify trends (2003-2017) in prevalence and in the proportion of individuals with hypertension attaining each step of the care cascade (awareness, treatment and control) among adults aged ≥17 years, and to assess the impact of lowering the blood pressure (BP) threshold on these indicators. Methods: We used data from three Chilean national health surveys (ENS 2003; 2010; 2017). Mean systolic (SBP) and diastolic (DBP) levels, hypertension prevalence (BP≥140/90 mmHg or use of antihypertensive treatment), and levels of awareness, treatment and control were assessed in each year. Logistic regression on pooled data was used to assess trends in hypertension prevalence and in its care cascade; linear regression was used to assess trends in SBP and DBP. We compared levels of hypertension prevalence using two sources to ascertain use of antihypertensive treatment (ATC codes from a detailed medicine inventory and self-reported use). The 2017 ACC/AHA guidelines were used to re-define hypertension using lower thresholds (BP≥130/80 mmHg or use of treatment). Results : Hypertension prevalence was 34.0%, 32.0% and 30.8% in 2003, 2010 and 2017, respectively. Mean SBP and DBP decreased over the 15-year period, except for SBP among females on treatment. Adopting the 2017 ACC/AHA guidelines would increase hypertension prevalence by 17% and 55% in absolute and relative terms, respectively. Levels of treated- and controlled-hypertension were significantly higher in 2017 than in 2003 (65% vs 41% for treatment; 34% vs 14% for control), while levels of awareness were stable (66% vs 59%). Gender disparities were evident, with higher awareness, treatment and control levels among females in 2003, 2010 and 2017. Conclusions: The introduction of universal access to care for hypertension in Chile in 2005 accounted partly for the rise in levels of treated- and controlled-hypertension since 2003. Lowering the BP threshold would substantially increase the financial public health challenge of further improving levels of attainment at each step of the care cascade. Innovative and collaborative strategies are needed to improve the management of hypertension, especially among males.

scholarly journals Hypertension care cascade in Chile: a serial cross-sectional study of national health surveys 2003-2010-2017

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Álvaro Passi-Solar ◽  
Paula Margozzini ◽  
Jennifer S. Mindell ◽  
Milagros Ruiz ◽  
Carlos A. Valencia-Hernandez ◽  
...  
Keyword(s):  
Blood Pressure ◽  
National Health ◽  
Health Surveys ◽  
Antihypertensive Treatment ◽  
Cross Sectional ◽  
Hypertension Prevalence ◽  
Care Cascade ◽  
And Control ◽  
The Impact ◽  
National Health Surveys

Abstract Background Trend data on hypertension prevalence and attainment indicators at each step of the care cascade (awareness, treatment, control) are required in Chile. This study aims to quantify trends (2003–2017) in prevalence and in the proportion of individuals with hypertension attaining each step of the care cascade among adults aged 17 years or older, and to assess the impact of lowering the blood pressure (BP) thresholds used to define elevated BP on these indicators. Methods We used data from 2003, 2010, and 2017 Chilean national health surveys. Each year we assessed levels of (1) mean systolic (SBP) and diastolic (DBP) blood pressure, (2) hypertension prevalence (BP ≥ 140/90 mmHg or use of antihypertensive treatment), and (3) awareness, treatment, and control. Logistic regression on pooled data was used to assess trends in binary outcomes; linear regression was used to assess trends in continuous SBP and DBP. We compared levels of hypertension prevalence using two sources to ascertain antihypertensive treatment (self-reported versus medicine inventory). The 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines were used to re-define hypertension using lower thresholds (BP ≥ 130/80 mmHg). Results Hypertension prevalence was 34.0, 32.0 and 30.8% in 2003, 2010 and 2017, respectively. Levels of treated- and controlled-hypertension were significantly higher in 2017 than in 2003 (65% versus 41% for treatment, P < 0.001; 34% versus 14% for control, P < 0.001), while levels of awareness were stable (66% versus 59%, P = 0.130). Awareness, treatment, and control levels were higher among females in 2003, 2010, and 2017 (P < 0.001). Mean SBP and DBP decreased over the 15-year period, except for SBP among females on treatment. Adopting the 2017 ACC/AHA guidelines would increase hypertension prevalence by 17 and 55% in absolute and relative terms, respectively. Conclusions Chile has experienced a positive population-wide lowering in blood pressure distribution which may be explained partly by a significant rise in levels of treated- and controlled-hypertension since 2003. Lowering the thresholds used to define elevated BP would substantially increase the financial public health challenge of further improving attainment levels at each step of the care cascade. Innovative and collaborative strategies are needed to improve hypertension management, especially among males.

Abstract P374: Trends in Hypertension Prevalence, Awareness, Treatment, and Control: The National Health and Nutrition Examination Survey, 1999-2014

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Kathryn Foti ◽  
Dan Wang ◽  
Elizabeth Selvin
Keyword(s):  
National Health ◽  
Hypertension Management ◽  
Nutrition Examination Survey ◽  
Hypertension Control ◽  
Hypertension Prevalence ◽  
Health And Nutrition ◽  
Younger Age ◽  
And Control ◽  
Over Time ◽  
Age Category

Introduction: The decline in cardiovascular disease mortality in the US has stalled in recent years, though patterns have varied by age and sociodemographic characteristics. Trends in prevalence of hypertension, as well as awareness, treatment, and control in population subgroups can shed light on opportunities for improving hypertension management and CVD prevention. Hypothesis: There has been greater improvement in hypertension control among adults aged ≥65 years than in middle- and younger-age (45-64 and 25-44 years) adults and that race and socioeconomic disparities may be narrower among adults aged ≥65 years. Methods: We analyzed data for adults aged ≥25 years from the 1999-2014 National Health and Nutrition Examination Survey (NHANES). We examined mean systolic blood pressure (SBP), prevalence of hypertension, and among those with hypertension, prevalence of awareness, treatment, and control by age category and survey cycle. We fit linear regression models for trends with interaction terms for age category and time. Results: Among those aged ≥65, mean SBP decreased 10.4 mmHg, from 143.2 to 132.9 mmHg, a significantly greater decrease than among those aged 45-64 (-3.1 mmHg) or 25-44 (-0.1 mmHg), though absolute SBP values are highest among those aged ≥65 ( Table ). Hypertension awareness, treatment, and control increased significantly each age category, but to a lesser extent among those 45-64 than those ≥65 (p-values for interaction: 0.031, 0.054, 0.051, respectively). Differences in hypertension control and mean SBP among whites and blacks were greater among those 45-64 than those ≥65. Within age categories, there were few significant differences in trends over time by race/ethnicity, education, or poverty to income ratio. Conclusions: Our findings highlight the need to address hypertension management among middle- and younger-age adults. Persistent disparities in hypertension control over time demonstrate that prevention and management of hypertension is a priority health equity issue.

Abstract 15595: Missed Targets: United States Trends in Hypertension Prevalence, Control, and Treatment 2005-2018

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Rahul Aggarwal ◽  
Nicholas Chiu ◽  
Rishi Wadhera ◽  
Changyu Shen ◽  
Robert W Yeh ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Temporal Trends ◽  
Cost Effective ◽  
Pressure Control ◽  
Healthy People ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Improve Blood Pressure Control ◽  
Hypertension Prevalence ◽  
And Control

Introduction: Hypertension is a major risk factor for cardiovascular disease. The US government, through the Healthy People Initiative 2020, set targets to improve hypertension prevalence and treatment rates in US adults by a relative 10% from 2005 to 2020, and increase control rates by a relative 40%. We examined US progress towards this goal from 2005-2018. Methods: We analyzed data from 38,876 non-pregnant US adults from the NHANES 2005-2018 surveys to determine nationally representative estimates of hypertension prevalence, treatment rates, and control. Temporal trends in hypertension prevalence, treatment, and control were assessed using weighted linear regression after age adjustment to the 2000 US census (per the Healthy People Initiative approach). In the base case, we defined hypertension as blood pressure >140/90 or on an antihypertensive; we used the ACC/AHA definition of blood pressure >130/80 in sensitivity analyses. Results: In 2017-2018, 34.3% (±1.7) of US adults had hypertension, of these 69.7% (±1.5) were on treatment, and 43.7% (±1.6) were controlled. After age-adjustment, no statistically significant changes in hypertension prevalence, treatment rates, or control were observed from 2005-2018 (p for trend 0.91, ,0.98, 0.66, Figure 1). In sensitivity analyses, applying the ACC/AHA definition increased the estimated prevalence of hypertension during the period, but trends in prevalence remained unchanged. Conclusions: There has been no material progress in reducing the prevalence of hypertension or improving rates of treatment and control from 2005 to 2018. As planning is underway for Healthy People Initiative 2030, setting of hypertension targets must be accompanied with investments in cost-effective, scalable programs to improve blood pressure control nationwide, with a focus on high-risk populations.

Abstract 604: Differences In The Prevalence And Control Of Hypertension Between Mercury Sphygmomanometer And Omron (hem_907xl): Nhanes 2009-2010

Hypertension ◽  
2012 ◽  
Vol 60 (suppl_1) ◽  
Author(s):  
Sarah Yoon ◽  
Tatiana Nwankwo ◽  
Margaret Carroll ◽  
Yechiam Ostchega
Keyword(s):  
Blood Pressure ◽  
Data Interpretation ◽  
Hypertension Control ◽  
Blood Pressure Monitor ◽  
Pressure Monitor ◽  
Hypertension Prevalence ◽  
Health And Nutrition ◽  
Subgroup Analyses ◽  
And Control ◽  
Mercury Sphygmomanometer

Objectives - Precise, reliable blood pressure (BP) measurement, whether in clinical practice or in epidemiological research, is essential for diagnosis and data interpretation. The study objectives were to compare differences in the prevalence and control of hypertension among adults aged 18 years and older using two standard devices: the mercury sphygmomanometer and the Omron Digital Blood Pressure Monitor (HEM_907XL). Methods - 5,185 individuals aged 18 years and older participated in the National Health and Nutrition Examination Survey 2009-2010 BP methodology study. Hypertension was defined as a mean systolic blood pressure (SBP) ≥ 140 mmHg or diastolic blood pressure (DBP) ≥ 90 mmHg, or currently taking BP medication. Mean BP was the average of up to three readings for each device. Controlled Hypertension among hypertensives was defined as SBP <140 mmHg and DBP < 90 mmHg. Results - Overall the age-adjusted prevalence of hypertension among adults was higher by mercury measurement (27.7%) than by Omron (26.4%, p <0.05). There were significant differences in hypertension prevalence between the two devices among men (mercury: 28.9% vs. Omron: 26.5%, p < 0.05) and Hispanics (mercury: 25.1% vs. Omron: 22.8%, p < 0.05). The overall hypertension control rate among hypertensives was significantly higher using Omron (64.6%) vs. mercury measurement (57.5%, p <0.05). In subgroup analyses, rates of hypertension control among hypertensives were systematically higher using Omron: for those 40-59 years (mercury: 60.0%; Omron: 67.9%); for those 60 years and older (mercury: 59.7%; Omron: 65.4%); for men (mercury: 54.9%; Omron: 63.9%); women (mercury: 61.5%; Omron: 66.1%,); non-Hispanic whites (mercury: 60.9%; Omron: 68.4%); non-Hispanic blacks(mercury: 48.8%; Omron: 54.3%); and Hispanics (mercury: 34.6%; Omron: 44.8%), ( p <0.05 for all groups). Conclusion - Hypertension prevalence measured by mercury was significantly higher than that measured by the Omron device. Lower Omron readings resulted in apparently higher estimates for the rate of controlled hypertension.

Ethnicity and hypertension

ESC CardioMed ◽  
2018 ◽  
pp. 2895-2898
Author(s):  
Bert-Jan van den Born ◽  
Charles Agyemang
Keyword(s):  
United States ◽  
Blood Pressure ◽  
Calcium Channel ◽  
Ethnic Differences ◽  
European Society ◽  
The United States ◽  
Hypertension Prevalence ◽  
Blocking Agents ◽  
Pressure Lowering ◽  
And Control

Worldwide, large differences exist in the prevalence of hypertension and hypertension-related complications, both along geographic boundaries and between different ethnic groups. Urbanization and dietary changes have led to a genuine increase in hypertension prevalence in many low- and middle-income countries, whereas migration has been associated with disparities in hypertension prevalence, awareness, and control in different, large multi-ethnic populations in Europe and the United States. Depending on the geographic area and definition of ethnicity, results can be quite heterogeneous and are susceptible to generalization. However, data in both Europe and the United States consistently show higher prevalence rates of hypertension and hypertension-related complications in populations of West African descent. These ethnic differences in hypertension susceptibility may in part be attributable to quantitative differences in other risk factors such as obesity and dietary salt intake, but may also relate to differences in pathophysiological traits, particularly increased salt sensitivity and vascular contractility. This may also explain the better blood pressure-lowering potential of salt restriction and of pharmacological treatment with diuretics and calcium channel blocking agents, whereas renin–angiotensin system blockers and beta-blocking agents are in general less effective. The European Society of Hypertension/European Society of Cardiology Guidelines recommend to start with calcium channel blockers or a thiazide diuretic for the treatment of hypertension in sub-Saharan African populations if no other compelling indications are present, while there is a lack of evidence that ethnicity should influence the preference for particular blood pressure-lowering combinations. The realization that ethnic differences in hypertension prevalence and treatment response exist may help to increase our understanding of the complex pathophysiology of hypertension and improve strategies aimed at the selection and control of hypertensive patients with different ethnic background.

scholarly journals Updated hypertension prevalence, awareness, and control rates based on the 2017ACC/AHA high blood pressure guideline

2019 ◽  
Vol 21 (6) ◽  
pp. 758-765 ◽  
Author(s):  
Yaqing Zhou ◽  
Limei Jia ◽  
Baojin Lu ◽  
Guoqiang Gu ◽  
Haijuan Hu ◽  
...  
Keyword(s):  
Blood Pressure ◽  
High Blood Pressure ◽  
Hypertension Prevalence ◽  
And Control
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