BLOOD PRESSURE LEVELS AND MORTALITY FROM CEREBROVASCULAR DISEASE IN AUSTRALIA AND THE UNITED STATES

Hypertension affects 80 million people in the United States. It remains poorly controlled, with only 54% of diagnosed patients treated to blood pressure targets. Hypertension management is complex in part due to the volume of antihypertensive agents, variable patient needs and responses, and inconsistent design and outcomes from clinical trials. Therefore, trustworthy clinical practice guidelines have a key role in hypertension management. The United States experienced a 10-year gap in publication of hypertension guidelines, followed by multiple guideline publications in 2013. These guidelines led to more controversy than clarity, as there was discordance among them. This review summarizes the guidelines and clinical statements influencing the current debate in order to facilitate appropriate application.

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Ethnicity and hypertension

ESC CardioMed ◽

10.1093/med/9780198784906.003.0700 ◽

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.

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Trends in antihypertensive drug use in the United States: do the JNC V recommendations affect prescribing? Fifth Joint National Commission on the Detection, Evaluation, and Treatment of High Blood Pressure

JAMA ◽

10.1001/jama.278.21.1745 ◽

1997 ◽

Vol 278 (21) ◽

pp. 1745-1748 ◽

Cited By ~ 24

Author(s):

D. Siegel

Keyword(s):

United States ◽

Blood Pressure ◽

Drug Use ◽

High Blood Pressure ◽

Antihypertensive Drug ◽

The United States ◽

National Commission ◽

Detection Evaluation

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Prevalence of Apparent Treatment-Resistant Hypertension in the United States According to the 2017 High Blood Pressure Guideline

Mayo Clinic Proceedings ◽

10.1016/j.mayocp.2018.12.033 ◽

2019 ◽

Vol 94 (5) ◽

pp. 776-782 ◽

Cited By ~ 8

Author(s):

Kershaw V. Patel ◽

Xilong Li ◽

Nitin Kondamudi ◽

Muthiah Vaduganathan ◽

Beverley Adams-Huet ◽

...

Keyword(s):

United States ◽

Blood Pressure ◽

High Blood Pressure ◽

Resistant Hypertension ◽

The United States ◽

Treatment Resistant

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PERSISTENT GENDER AND RACIAL DIFFERENCES IN MORTALITY FROM ISCHEMIC HEART DISEASE AND CEREBROVASCULAR DISEASE IN THE UNITED STATES: 1999 TO 2017

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(20)30633-1 ◽

2020 ◽

Vol 75 (11) ◽

pp. 6

Author(s):

Mohammed Essa ◽

Augustin Delago ◽

Matthew Hammond-Haley ◽

Joseph Shalhouub ◽

Dominic Marshall ◽

...

Keyword(s):

United States ◽

Heart Disease ◽

Ischemic Heart Disease ◽

Cerebrovascular Disease ◽

Racial Differences ◽

The United States ◽

Ischemic Heart

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Forty-Year Shifting Distribution of Systolic Blood Pressure With Population Hypertension Treatment and Control

Circulation ◽

10.1161/circulationaha.120.048063 ◽

2020 ◽

Vol 142 (16) ◽

pp. 1524-1531 ◽

Cited By ~ 1

Author(s):

Daniel T. Lackland ◽

Virginia J. Howard ◽

Mary Cushman ◽

Suzanne Oparil ◽

Brett Kissela ◽

...

Keyword(s):

United States ◽

Blood Pressure ◽

High Risk ◽

Racial Differences ◽

The United States ◽

Hypertension Treatment ◽

Heart Study ◽

Blacks And Whites ◽

The 1960S ◽

And Control

Background: Hypertension awareness, treatment, and control programs were initiated in the United States during the 1960s and 1970s. Whereas blood pressure (BP) control in the population and subsequent reduced hypertension-related disease risks have improved since the implementation of these interventions, it is unclear whether these BP changes can be generalized to diverse and high-risk populations. This report describes the 4-decade change in BP levels for the population in a high disease risk southeastern region of the United States. The objective is to determine the magnitude of the shift in systolic BP (SBP) among Blacks and Whites from the Southeast between 1960 and 2005 with the assessment of the unique population cohorts. Methods: A multicohort study design compared BPs from the CHS (Charleston Heart Study) and ECHS (Evans County Heart Study) in 1960 and the REGARDS study (Reasons for Geographic and Racial Differences in Stroke) 4 decades later. The analyses included participants ≥45 years of age from CHS (n=1323), ECHS (n=1842), and REGARDS (n=6294) with the main outcome of SBP distribution. Results: Among Whites 45 to 54 years of age, the median SBP was 18 mm Hg (95% CI, 16–21 mm Hg) lower in 2005 than 1960. The median shift was a 45 mm Hg (95% CI, 37–51 mm Hg) decline for those ≥75 years of age. The shift was larger for Blacks, with median declines of 38 mm Hg (95% CI, 32–40 mm Hg) at 45 to 54 years of age and 50 mm Hg (95% CI, 33–60 mm Hg) for ages ≥75 years. The 95th percentile of SBP decreased 60 mm Hg for Whites and 70 mm Hg for Blacks. Conclusions: The results of the current analyses of the unique cohorts in the Southeast confirm the improvements in population SBP levels since 1960. This assessment provides new evidence of improvement in SBP, suggesting that strategies and programs implemented to improve hypertension treatment and control have been extraordinarily successful for both Blacks and Whites residing in a high-risk region of the United States. Severe BP elevations commonly observed in the 1960s have been nearly eliminated, with the current 75th percentile of BP generally less than the 25th percentile of BP in 1960.

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