Background:
High blood pressure and cholesterol are leading risk factors for cardiovascular disease (CVD). The Behavioral Risk Factor Surveillance System (BRFSS) is currently the only system that can provide state-level estimates of high blood pressure and cholesterol, and states frequently use the BRFSS when monitoring CVD risk factors. Several methodological changes to the BRFSS were instituted in 2011, to account for rising rates of cellular phone only households and declining response rates. The improvements may result in shifts to state-level estimates, and comparisons with previous years may represent methodological changes, rather than risk factor improvement or worsening. New baseline data are needed and this study uses the most recent data to report high blood pressure and cholesterol estimates among US states.
Methods:
The BRFSS is a state-based, random-digit-dialed telephone survey of non-institutionalized US adults aged ≥18 years. High blood pressure and cholesterol are assessed in odd years, using: “Have you ever been told by a doctor, nurse, or other health professional that you have high blood pressure [¼your high blood cholesterol is high]?” Data were analyzed by age, sex, race/ethnicity, education, and state. All estimates were age standardized using the 2000 US standard projected population. Analyses were conducted using SAS-callable SUDAAN to account for the complex sampling design. Within group differences were assessed using pairwise comparisons. The analytic sample was 498,201.
Results:
Overall, 30.3% (95% Confidence Interval: 30.0-30.5%) reported high blood pressure and 34.0% (33.7-34.3%) high cholesterol. Compared with other demographic groups, higher estimates of high blood pressure were reported among males, those with < a high school education, non-Hispanic blacks, and those ≥65 years. In parallel, high cholesterol was most commonly reported among males, those with < a high school education, and those ≥65 years, with non-Hispanic blacks reporting the lowest prevalence, compared with other demographic groups. By state, reported high blood pressure ranged from 24.7% (Colorado) to 38.3% (Mississippi) and high cholesterol from 28.0% (Montana) to 37.8% (Texas).
Conclusions:
In 2011, about 1 in 3 US adults reported high blood pressure and high cholesterol. Marked demographic and geographic disparities were found. Coordinated community and clinical interventions are needed to address the high burden of high blood pressure and cholesterol. For example, the Million Hearts
TM
initiative, a public-private partnership, seeks to align, coordinate, and enhance activities across the US, with prevention and treatment of high blood pressure and cholesterol being key components of the initiative.
Comparing self-reported and measured high blood pressure and high cholesterol status using data from a large representative cohort study
