Hypertension in the United States 1999-2012: Progress Toward Healthy People 2020 Goals
Background—To reduce the cardiovascular disease burden, Healthy People 2020 established U.S. hypertension goals for adults to: (1) decrease prevalence to 26.9%. (2) raise treatment to 69.5% and control to 61.2%, which requires controlling 88.1% on treatment.
Methods and Results—To assess current status and progress toward these Healthy People 2020 goals, time trends in National Health and Nutrition Examination Surveys 1999-2012 data in two-year blocks were assessed in adults ≥18 years old age-adjusted to U.S. 2010. From 1999-2000 to 2011-2012, prevalent hypertension was unchanged (30.1% vs. 30.8%, p=0.32). Hypertension treatment (59.8% vs. 74.7%, p<0.001) and proportion of treated adults controlled (53.3% to 68.9%, p=0.0015) increased. Hypertension control to <140/<90 mmHg rose every two years from 1999-2000 to 2009-2010 (32.2% vs. 53.8%, p<0.001) before declining to 51.2% in 2011-2012. Modifiable factor(s) significant in multivariable logistic regression modeling include: (a) increasing body mass index with prevalent hypertension (odds ratio [OR] 1.44). (b) lack of health insurance (OR 1.68) and <2 healthcare visits/year (OR 4.24) with untreated hypertension. (c) healthcare insurance (OR 1.69), ≥2 healthcare visits/year (OR 3.23) and cholesterol treatment (OR 1.90) with controlled hypertension.
Conclusions—The NHANES 1999-2012 analysis suggests that Healthy People 2020 goals for hypertension: (1) prevalence show no progress (2) treatment was exceeded (3) control has flattened below target. Findings are consistent with evidence that: (a) obesity prevention and treatment could reduce prevalent hypertension (b) healthcare insurance, ≥2 healthcare visits/year, and guideline-based cholesterol treatment could improve hypertension control.
- Received April 17, 2014.
- Revision received July 23, 2014.
- Accepted August 18, 2014.