Original Article Trends in the Prevalence, Awareness, Treatment, and Control of Hypertension Among Young Adults in the United States, 1999 to 2014 Yiyi Zhang, Andrew E. Moran
Downloaded from http://hyper.ahajournals.org/ by guest on August 30, 2017
Abstract—Overall hypertension prevalence has not changed in the United States in recent decades although awareness, treatment, and control improved. However, hypertension epidemiology and its temporal trends may differ in younger adults compared with older adults. Our study included 41 331 participants ≥18 years of age from 8 National Health and Nutrition Examination Surveys (1999–2014) and estimated temporal trends of hypertension, awareness, treatment, and control among young adults (age, 18–39 years) compared with middle-age (age, 40–59 years) and older adults (age, ≥60 years). In 2013 to 2014, 7.3% of the US young adults had hypertension. During 1999 to 2014, young adults saw larger increases in hypertension awareness, treatment, and control than did older adults. However, all of these components of hypertension control were lower among young adults compared with middle-aged or older adults (74.7% younger versus 81.9% middle versus 88.4% older for awareness; 50.0% versus 70.3% versus 83.0% for treatment; and 40.2% versus 56.7% versus 54.4% for control). Worse hypertension awareness, treatment, and control in young adults overall were mostly driven by worse measures in young adult men compared with young adult women. More frequent healthcare visits by young adult women explained ≈28% of the sex-related difference in awareness, 60% of the difference in treatment, and 52% of the difference in control. These findings suggest that improved access to and engagement in medical care might improve hypertension control in young adults, particularly young adult men, and reduce life-time cardiovascular risk. (Hypertension. 2017;70:00-00. DOI: 10.1161/HYPERTENSIONAHA.117.09801.) Online Data Supplement
•
Key Words: blood pressure
■
body mass index
■
cardiovascular diseases
H
■
hypertension
■
young adult
risk factor for stroke, and ≈10% of all strokes occur in individuals 18 to 50 years of age.13–15 In contrast to the decline in overall age-adjusted rates of stroke mortality and hospitalization in the past 2 decades, hospitalization for acute ischemic stroke increased significantly among young adults 10% since 2010, representing an increase of ≈6.1 million young adults with access to a regular source of medical care, and potentially, prevention programs.36 In our analysis, health insurance coverage alone
6 Hypertension October 2017
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did not explain low hypertension awareness, treatment, or control in young adult men, suggesting that low preventive services uptake may be more important than insurance status in this group. For young adult men without access to care or infrequent preventive care visits, hypertension awareness, treatment, and control may only be improved outside of traditional clinical settings. School or worksite-based health screening may reach young adults more successfully.37 Young men may respond more favorably and link to primary care if blood pressure screening is performed by trained and trusted laypeople, like barbers.38 Future studies are needed to assess the effectiveness of these strategies in improving awareness and control of hypertension among young adult men. A few limitations of this study need to be considered. Blood pressure was measured during a single visit and may result in misclassification of some of the participants. Hypertension awareness, medication use, insurance coverage, and number of healthcare visits were based on self-report and potentially subject to recall bias. Although we assessed health insurance status, we were not able to assess the quality of preventive services covered by participants’ insurance plans. In addition, our study only evaluated medication use for blood pressure control. Lifestyle modifications, such as low sodium intake or physical activity, were not examined in the present analysis. Although our study included a large sample size, the number of young adults who had hypertension was relatively small in each survey cycle. Therefore, hypertension awareness, treatment, and control could not be reliably estimated by race/ethnicity for some of the survey cycles. The strength of our study includes the use of nationally representative data, the rigorous study protocol, and quality-control procedures of NHANES. The large sample size and 16 years of data also allowed us to estimate age-specific trends with high precision.
Perspectives The prevalence of hypertension remained unchanged from 1999 to 2014 among US young adults, along with improvements in hypertension awareness, treatment, and control. However, despite this progress, young adults lag behind older adults in hypertension awareness, treatment, and control. Worse hypertension awareness and management among young adults appeared to be mostly driven by deficits in young adult men, not by women, which may be explained, in part, by limited healthcare access or less frequent medical care use in young adult men. These findings highlight important gaps in today’s approach to blood pressure control and primary prevention of cardiovascular disease, as well as potential opportunities for reducing future burden of cardiovascular disease and advancing cardiovascular health in the coming decades as today’s young adults transition into middle and late adulthood. Further research is needed to better understand and address age and sex gaps in hypertension awareness and control and quantify the expected future benefits of controlling blood pressure in today’s young adults.
Sources of Funding This work was supported by National Institutes of Health R01 HL130500 (A.E. Moran).
Disclosures None.
References 1. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ; National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure Education Program Coordinating Committee. The Seventh Report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA. 2003;289:2560–2572. doi: 10.1001/jama.289.19.2560. 2. Benjamin EJ, Blaha MJ, Chiuve SE, et al; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2017 Update: a report from the American Heart Association. Circulation. 2017;135:e146–e603. doi: 10.1161/ CIR.0000000000000485. 3. Hajjar I, Kotchen TA. Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988-2000. JAMA. 2003;290:199–206. doi: 10.1001/jama.290.2.199. 4. Egan BM, Zhao Y, Axon RN. US trends in prevalence, awareness, treatment, and control of hypertension, 1988-2008. JAMA. 2010;303:2043– 2050. doi: 10.1001/jama.2010.650. 5. Yoon SS, Ostchega Y, Louis T. Recent trends in the prevalence of high blood pressure and its treatment and control, 1999–2008. NCHS Data Brief. 2010:1–8. 6. Guo F, He D, Zhang W, Walton RG. Trends in prevalence, awareness, management, and control of hypertension among United States adults, 1999 to 2010. J Am Coll Cardiol. 2012;60:599–606. doi: 10.1016/j.jacc.2012.04.026. 7. Yoon SS, Gu Q, Nwankwo T, Wright JD, Hong Y, Burt V. Trends in blood pressure among adults with hypertension: United States, 2003 to 2012. Hypertension. 2015;65:54–61. doi: 10.1161/ HYPERTENSIONAHA.114.04012. 8. Yoon SS, Carroll MD, Fryar CD. Hypertension prevalence and control among adults: United states, 2011–2014. NCHS Data Brief. 2015:1–8. 9. Pletcher MJ, Bibbins-Domingo K, Lewis CE, Wei GS, Sidney S, Carr JJ, Vittinghoff E, McCulloch CE, Hulley SB. Prehypertension during young adulthood and coronary calcium later in life. Ann Intern Med. 2008;149:91–99. 10. Allen NB, Siddique J, Wilkins JT, Shay C, Lewis CE, Goff DC, Jacobs DR Jr, Liu K, Lloyd-Jones D. Blood pressure trajectories in early adulthood and subclinical atherosclerosis in middle age. JAMA. 2014;311:490– 497. doi: 10.1001/jama.2013.285122. 11. Pletcher MJ, Vittinghoff E, Thanataveerat A, Bibbins-Domingo K, Moran AE. Young adult exposure to cardiovascular risk factors and risk of events later in life: the Framingham Offspring Study. PLoS One. 2016;11:e0154288. doi: 10.1371/journal.pone.0154288. 12. Gray L, Lee IM, Sesso HD, Batty GD. Blood pressure in early adulthood, hypertension in middle age, and future cardiovascular disease mortality: HAHS (Harvard Alumni Health Study). J Am Coll Cardiol. 2011;58:2396–2403. doi: 10.1016/j.jacc.2011.07.045. 13. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R; Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360:1903–1913. 14. Nedeltchev K, der Maur TA, Georgiadis D, Arnold M, Caso V, Mattle HP, Schroth G, Remonda L, Sturzenegger M, Fischer U, Baumgartner RW. Ischaemic stroke in young adults: predictors of outcome and recurrence. J Neurol Neurosurg Psychiatry. 2005;76:191–195. doi: 10.1136/ jnnp.2004.040543. 15. Béjot Y, Daubail B, Jacquin A, Durier J, Osseby GV, Rouaud O, Giroud M. Trends in the incidence of ischaemic stroke in young adults between 1985 and 2011: the Dijon Stroke Registry. J Neurol Neurosurg Psychiatry. 2014;85:509–513. doi: 10.1136/jnnp-2013-306203. 16. George MG, Tong X, Bowman BA. Prevalence of cardiovascular risk factors and strokes in younger adults. JAMA Neurol. 2017;74:695–703. doi: 10.1001/jamaneurol.2017.0020. 17. Ramirez L, Kim-Tenser MA, Sanossian N, Cen S, Wen G, He S, Mack WJ, Towfighi A. Trends in acute ischemic stroke hospitalizations in the United States. J Am Heart Assoc. 2016;5. 18. Ogden CL, Carroll MD, Lawman HG, Fryar CD, Kruszon-Moran D, Kit BK, Flegal KM. Trends in obesity prevalence among children and adolescents in the United States, 1988-1994 through 2013-2014. JAMA. 2016;315:2292–2299. doi: 10.1001/jama.2016.6361.
Zhang and Moran Trends in Hypertension Among US Young Adults 7
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19. Bibbins-Domingo K, Coxson P, Pletcher MJ, Lightwood J, Goldman L. Adolescent overweight and future adult coronary heart disease. N Engl J Med. 2007;357:2371–2379. doi: 10.1056/NEJMsa073166. 20. Zipf G, Chiappa M, Porter KS, Ostchega Y, Lewis BG, Dostal J. National Health and Nutrition Examination Survey: plan and operations, 1999– 2010. Vital Health Stat 1. 2013:1–37. 21. National Center for Health Statistics. National Health and Nutrition Examination Survey (NHANES). NHANES response rates and population totals. http://www.cdc.gov/nchs/nhanes/response_rates_cps.htm. Accessed April 11, 2017. 22. Crim MT, Yoon SS, Ortiz E, Wall HK, Schober S, Gillespie C, Sorlie P, Keenan N, Labarthe D, Hong Y. National surveillance definitions for hypertension prevalence and control among adults. Circ Cardiovasc Qual Outcomes. 2012;5:343–351. doi: 10.1161/ CIRCOUTCOMES.111.963439. 23. Booth JN, 3rd, Li J, Zhang L, Chen L, Muntner P, Egan B. Trends in prehypertension and hypertension risk factors in us adults: 1999–2012. Hypertension. 2017;70:275–284. doi: 10.1161/ HYPERTENSIONAHA.116.09004. 24. Jamal A, Homa DM, O’Connor E, Babb SD, Caraballo RS, Singh T, Hu SS, King BA. Current cigarette smoking among adults–United States, 2005-2014. MMWR Morb Mortal Wkly Rep. 2015;64:1233–1240. doi: 10.15585/mmwr.mm6444a2. 25. Healthy People 2020. Washington, DC: U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. http://www.healthypeople.gov/2020/topics-objectives/topic/heart-disease-and-stroke/objectives. Accessed April 20, 2017. 26. James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311:507–520. doi: 10.1001/jama.2013.284427. 27. Calhoun DA, Jones D, Textor S, Goff DC, Murphy TP, Toto RD, White A, Cushman WC, White W, Sica D, Ferdinand K, Giles TD, Falkner B, Carey RM. Resistant hypertension: diagnosis, evaluation, and treatment. A scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Hypertension. 2008;51:1403–1419. doi: 10.1161/ HYPERTENSIONAHA.108.189141. 28. Egan BM, Zhao Y, Axon RN, Brzezinski WA, Ferdinand KC. Uncontrolled and apparent treatment resistant hypertension in the United
States, 1988 to 2008. Circulation. 2011;124:1046–1058. doi: 10.1161/ CIRCULATIONAHA.111.030189. 29. Sarganas G, Neuhauser HK. The persisting gender gap in hypertension management and control in Germany: 1998 and 2008-2011. Hypertens Res. 2016;39:457–466. doi: 10.1038/hr.2016.5. 30. Wang J, Zhang L, Wang F, Liu L, Wang H; China National Survey of Chronic Kidney Disease Working Group. Prevalence, awareness, treatment, and control of hypertension in China: results from a national survey. Am J Hypertens. 2014;27:1355–1361. doi: 10.1093/ajh/hpu053. 31. Choi HM, Kim HC, Kang DR. Sex differences in hypertension prevalence and control: analysis of the 2010-2014 Korea National Health and Nutrition Examination Survey. PLoS One. 2017;12:e0178334. doi: 10.1371/journal.pone.0178334. 32. Brett KM, Burt CW. Utilization of ambulatory medical care by women: United states, 1997–98. Vital Health Stat. 2001;13:1–46. 33. Paulose-Ram R, Gu Q, Kit B. Characteristics of U.S. adults with hypertension who are unaware of their hypertension, 2011–2014. NCHS Data Brief. 2017:1–8. 34. Ostchega Y, Hughes JP, Wright JD, McDowell MA, Louis T. Are demographic characteristics, health care access and utilization, and comorbid conditions associated with hypertension among US adults? Am J Hypertens. 2008;21:159–165. doi: 10.1038/ajh.2007.32. 35. Gooding HC, McGinty S, Richmond TK, Gillman MW, Field AE. Hypertension awareness and control among young adults in the national longitudinal study of adolescent health. J Gen Intern Med. 2014;29:1098– 1104. doi: 10.1007/s11606-014-2809-x. 36. Uberoi N, Finegold K, Gee E. Health insurance coverage and the affordable care act, 2010–2016. http://aspe.hhs.gov/system/files/pdf/187551/ ACA2010-2016.pdf. Accessed July 26, 2017. 37. Fonarow GC, Calitz C, Arena R, Baase C, Isaac FW, Lloyd-Jones D, Peterson ED, Pronk N, Sanchez E, Terry PE, Volpp KG, Antman EM, American Heart Association. Workplace wellness recognition for optimizing workplace health: a presidential advisory from the American Heart Association. Circulation. 2015;131:e480–e497. doi: 10.1161/CIR.0000000000000206. 38. Victor RG, Ravenell JE, Freeman A, Leonard D, Bhat DG, Shafiq M, Knowles P, Storm JS, Adhikari E, Bibbins-Domingo K, Coxson PG, Pletcher MJ, Hannan P, Haley RW. Effectiveness of a barber-based intervention for improving hypertension control in black men: the BARBER-1 study: a cluster randomized trial. Arch Intern Med. 2011;171:342–350. doi: 10.1001/archinternmed.2010.390.
Novelty and Significance What Is New?
Summary
• Hypertension awareness, treatment, and control improved in US young
There remain important quality gaps in today’s approach to blood pressure control in young adults. Public health efforts to improve blood pressure control among young adults, particularly men, should focus on raising awareness and improving outreach in medical, worksite, and community settings.
adults in the past 15 years but remained substantially lower compared with middle-aged and older adults. • Young adult men had worse hypertension awareness, treatment, and control compared with young adult women.
What Is Relevant?
• In 2013 to 2014, 6.7 million US young adults had hypertension, of whom only 50% were treated and 40% controlled.
Trends in the Prevalence, Awareness, Treatment, and Control of Hypertension Among Young Adults in the United States, 1999 to 2014 Yiyi Zhang and Andrew E. Moran Downloaded from http://hyper.ahajournals.org/ by guest on August 30, 2017
Hypertension. published online August 28, 2017; Hypertension is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231 Copyright © 2017 American Heart Association, Inc. All rights reserved. Print ISSN: 0194-911X. Online ISSN: 1524-4563
The online version of this article, along with updated information and services, is located on the World Wide Web at: http://hyper.ahajournals.org/content/early/2017/08/28/HYPERTENSIONAHA.117.09801
Data Supplement (unedited) at: http://hyper.ahajournals.org/content/suppl/2017/08/25/HYPERTENSIONAHA.117.09801.DC1
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Trends in the Prevalence, Awareness, Treatment, and Control of Hypertension among Young Adults in the United States, 1999-2014
Yiyi Zhang, PhD,1 Andrew E Moran, MD, MPH1
1
Division of General Medicine, Columbia University, New York, NY
Correspondence: Andrew E. Moran, MD, MPH, Columbia University Division of General Medicine, Presbyterian Hospital, 9th Fl. East, Rm. 105, 622 West 168th St., New York, NY 10032, Tel: 212-305-2569, Email: [email protected]
Brief title: Trends in hypertension among U.S. young adults
Word count (abstract): 232 Word count (text): 3,076 Total number of figures: 4
1
Table S1. Age-standardized weighted prevalence (standard error) of hypertension, and awareness, treatment, and control of hypertension per 100 adults in the US general population Overall Age groups
Total N
Cases
By NHANES survey cycle 19992000 (n = 4,487)
20012002 (n = 4,945)
20032004 (n = 4,668)
20052006 (n = 4,693)
20072008 (n = 5,615)
20092010 (n = 5,988)
20112012 (n = 5,294)
20132014 (n = 5,641)
P-trend
Hypertension All Age (years) 18-39 40-59 ≥60 P-value
41,331 14,229
28.7 (1.4)
28.0 (0.9)
29.7 (1.1)
29.0 (1.0)
29.6 (0.7)
28.5 (0.9)
28.7 (0.7)
29.4 (0.9)
15,669 12,490 13,172
7.6 (1.6) 30.2 (2.0) 66.1 (1.9)
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Abstract—Overall hypertension prevalence has not changed in the United States in recent decades although awareness, treatment, and control improved. However, hypertension epidemiology and its temporal trends may differ in younger adults compared with older adults. Our study included 41 331 participants ≥18 years of age from 8 National Health and Nutrition Examination Surveys (1999–2014) and estimated temporal trends of hypertension, awareness, treatment, and control among young adults (age, 18–39 years) compared with middle-age (age, 40–59 years) and older adults (age, ≥60 years). In 2013 to 2014, 7.3% of the US young adults had hypertension. During 1999 to 2014, young adults saw larger increases in hypertension awareness, treatment, and control than did older adults. However, all of these components of hypertension control were lower among young adults compared with middle-aged or older adults (74.7% younger versus 81.9% middle versus 88.4% older for awareness; 50.0% versus 70.3% versus 83.0% for treatment; and 40.2% versus 56.7% versus 54.4% for control). Worse hypertension awareness, treatment, and control in young adults overall were mostly driven by worse measures in young adult men compared with young adult women. More frequent healthcare visits by young adult women explained ≈28% of the sex-related difference in awareness, 60% of the difference in treatment, and 52% of the difference in control. These findings suggest that improved access to and engagement in medical care might improve hypertension control in young adults, particularly young adult men, and reduce life-time cardiovascular risk. (Hypertension. 2017;70:00-00. DOI: 10.1161/HYPERTENSIONAHA.117.09801.) Online Data Supplement
•
Key Words: blood pressure
■
body mass index
■
cardiovascular diseases
H
■
hypertension
■
young adult
risk factor for stroke, and ≈10% of all strokes occur in individuals 18 to 50 years of age.13–15 In contrast to the decline in overall age-adjusted rates of stroke mortality and hospitalization in the past 2 decades, hospitalization for acute ischemic stroke increased significantly among young adults 10% since 2010, representing an increase of ≈6.1 million young adults with access to a regular source of medical care, and potentially, prevention programs.36 In our analysis, health insurance coverage alone
6 Hypertension October 2017
Downloaded from http://hyper.ahajournals.org/ by guest on August 30, 2017
did not explain low hypertension awareness, treatment, or control in young adult men, suggesting that low preventive services uptake may be more important than insurance status in this group. For young adult men without access to care or infrequent preventive care visits, hypertension awareness, treatment, and control may only be improved outside of traditional clinical settings. School or worksite-based health screening may reach young adults more successfully.37 Young men may respond more favorably and link to primary care if blood pressure screening is performed by trained and trusted laypeople, like barbers.38 Future studies are needed to assess the effectiveness of these strategies in improving awareness and control of hypertension among young adult men. A few limitations of this study need to be considered. Blood pressure was measured during a single visit and may result in misclassification of some of the participants. Hypertension awareness, medication use, insurance coverage, and number of healthcare visits were based on self-report and potentially subject to recall bias. Although we assessed health insurance status, we were not able to assess the quality of preventive services covered by participants’ insurance plans. In addition, our study only evaluated medication use for blood pressure control. Lifestyle modifications, such as low sodium intake or physical activity, were not examined in the present analysis. Although our study included a large sample size, the number of young adults who had hypertension was relatively small in each survey cycle. Therefore, hypertension awareness, treatment, and control could not be reliably estimated by race/ethnicity for some of the survey cycles. The strength of our study includes the use of nationally representative data, the rigorous study protocol, and quality-control procedures of NHANES. The large sample size and 16 years of data also allowed us to estimate age-specific trends with high precision.
Perspectives The prevalence of hypertension remained unchanged from 1999 to 2014 among US young adults, along with improvements in hypertension awareness, treatment, and control. However, despite this progress, young adults lag behind older adults in hypertension awareness, treatment, and control. Worse hypertension awareness and management among young adults appeared to be mostly driven by deficits in young adult men, not by women, which may be explained, in part, by limited healthcare access or less frequent medical care use in young adult men. These findings highlight important gaps in today’s approach to blood pressure control and primary prevention of cardiovascular disease, as well as potential opportunities for reducing future burden of cardiovascular disease and advancing cardiovascular health in the coming decades as today’s young adults transition into middle and late adulthood. Further research is needed to better understand and address age and sex gaps in hypertension awareness and control and quantify the expected future benefits of controlling blood pressure in today’s young adults.
Sources of Funding This work was supported by National Institutes of Health R01 HL130500 (A.E. Moran).
Disclosures None.
References 1. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ; National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure Education Program Coordinating Committee. The Seventh Report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA. 2003;289:2560–2572. doi: 10.1001/jama.289.19.2560. 2. Benjamin EJ, Blaha MJ, Chiuve SE, et al; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2017 Update: a report from the American Heart Association. Circulation. 2017;135:e146–e603. doi: 10.1161/ CIR.0000000000000485. 3. Hajjar I, Kotchen TA. Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988-2000. JAMA. 2003;290:199–206. doi: 10.1001/jama.290.2.199. 4. Egan BM, Zhao Y, Axon RN. US trends in prevalence, awareness, treatment, and control of hypertension, 1988-2008. JAMA. 2010;303:2043– 2050. doi: 10.1001/jama.2010.650. 5. Yoon SS, Ostchega Y, Louis T. Recent trends in the prevalence of high blood pressure and its treatment and control, 1999–2008. NCHS Data Brief. 2010:1–8. 6. Guo F, He D, Zhang W, Walton RG. Trends in prevalence, awareness, management, and control of hypertension among United States adults, 1999 to 2010. J Am Coll Cardiol. 2012;60:599–606. doi: 10.1016/j.jacc.2012.04.026. 7. Yoon SS, Gu Q, Nwankwo T, Wright JD, Hong Y, Burt V. Trends in blood pressure among adults with hypertension: United States, 2003 to 2012. Hypertension. 2015;65:54–61. doi: 10.1161/ HYPERTENSIONAHA.114.04012. 8. Yoon SS, Carroll MD, Fryar CD. Hypertension prevalence and control among adults: United states, 2011–2014. NCHS Data Brief. 2015:1–8. 9. Pletcher MJ, Bibbins-Domingo K, Lewis CE, Wei GS, Sidney S, Carr JJ, Vittinghoff E, McCulloch CE, Hulley SB. Prehypertension during young adulthood and coronary calcium later in life. Ann Intern Med. 2008;149:91–99. 10. Allen NB, Siddique J, Wilkins JT, Shay C, Lewis CE, Goff DC, Jacobs DR Jr, Liu K, Lloyd-Jones D. Blood pressure trajectories in early adulthood and subclinical atherosclerosis in middle age. JAMA. 2014;311:490– 497. doi: 10.1001/jama.2013.285122. 11. Pletcher MJ, Vittinghoff E, Thanataveerat A, Bibbins-Domingo K, Moran AE. Young adult exposure to cardiovascular risk factors and risk of events later in life: the Framingham Offspring Study. PLoS One. 2016;11:e0154288. doi: 10.1371/journal.pone.0154288. 12. Gray L, Lee IM, Sesso HD, Batty GD. Blood pressure in early adulthood, hypertension in middle age, and future cardiovascular disease mortality: HAHS (Harvard Alumni Health Study). J Am Coll Cardiol. 2011;58:2396–2403. doi: 10.1016/j.jacc.2011.07.045. 13. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R; Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360:1903–1913. 14. Nedeltchev K, der Maur TA, Georgiadis D, Arnold M, Caso V, Mattle HP, Schroth G, Remonda L, Sturzenegger M, Fischer U, Baumgartner RW. Ischaemic stroke in young adults: predictors of outcome and recurrence. J Neurol Neurosurg Psychiatry. 2005;76:191–195. doi: 10.1136/ jnnp.2004.040543. 15. Béjot Y, Daubail B, Jacquin A, Durier J, Osseby GV, Rouaud O, Giroud M. Trends in the incidence of ischaemic stroke in young adults between 1985 and 2011: the Dijon Stroke Registry. J Neurol Neurosurg Psychiatry. 2014;85:509–513. doi: 10.1136/jnnp-2013-306203. 16. George MG, Tong X, Bowman BA. Prevalence of cardiovascular risk factors and strokes in younger adults. JAMA Neurol. 2017;74:695–703. doi: 10.1001/jamaneurol.2017.0020. 17. Ramirez L, Kim-Tenser MA, Sanossian N, Cen S, Wen G, He S, Mack WJ, Towfighi A. Trends in acute ischemic stroke hospitalizations in the United States. J Am Heart Assoc. 2016;5. 18. Ogden CL, Carroll MD, Lawman HG, Fryar CD, Kruszon-Moran D, Kit BK, Flegal KM. Trends in obesity prevalence among children and adolescents in the United States, 1988-1994 through 2013-2014. JAMA. 2016;315:2292–2299. doi: 10.1001/jama.2016.6361.
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Novelty and Significance What Is New?
Summary
• Hypertension awareness, treatment, and control improved in US young
There remain important quality gaps in today’s approach to blood pressure control in young adults. Public health efforts to improve blood pressure control among young adults, particularly men, should focus on raising awareness and improving outreach in medical, worksite, and community settings.
adults in the past 15 years but remained substantially lower compared with middle-aged and older adults. • Young adult men had worse hypertension awareness, treatment, and control compared with young adult women.
What Is Relevant?
• In 2013 to 2014, 6.7 million US young adults had hypertension, of whom only 50% were treated and 40% controlled.
Trends in the Prevalence, Awareness, Treatment, and Control of Hypertension Among Young Adults in the United States, 1999 to 2014 Yiyi Zhang and Andrew E. Moran Downloaded from http://hyper.ahajournals.org/ by guest on August 30, 2017
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Trends in the Prevalence, Awareness, Treatment, and Control of Hypertension among Young Adults in the United States, 1999-2014
Yiyi Zhang, PhD,1 Andrew E Moran, MD, MPH1
1
Division of General Medicine, Columbia University, New York, NY
Correspondence: Andrew E. Moran, MD, MPH, Columbia University Division of General Medicine, Presbyterian Hospital, 9th Fl. East, Rm. 105, 622 West 168th St., New York, NY 10032, Tel: 212-305-2569, Email: [email protected]
Brief title: Trends in hypertension among U.S. young adults
Word count (abstract): 232 Word count (text): 3,076 Total number of figures: 4
1
Table S1. Age-standardized weighted prevalence (standard error) of hypertension, and awareness, treatment, and control of hypertension per 100 adults in the US general population Overall Age groups
Total N
Cases
By NHANES survey cycle 19992000 (n = 4,487)
20012002 (n = 4,945)
20032004 (n = 4,668)
20052006 (n = 4,693)
20072008 (n = 5,615)
20092010 (n = 5,988)
20112012 (n = 5,294)
20132014 (n = 5,641)
P-trend
Hypertension All Age (years) 18-39 40-59 ≥60 P-value
41,331 14,229
28.7 (1.4)
28.0 (0.9)
29.7 (1.1)
29.0 (1.0)
29.6 (0.7)
28.5 (0.9)
28.7 (0.7)
29.4 (0.9)
15,669 12,490 13,172
7.6 (1.6) 30.2 (2.0) 66.1 (1.9)
