| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Hypertension. 2000;36:594.)
© 2000 American Heart Association, Inc.
Scientific Contributions |
Differential Control of Systolic and Diastolic Blood Pressure
Factors Associated With Lack of Blood Pressure Control in the Community
From the National Heart, Lung, and Blood Institute’s Framingham Heart Study (D.M.L.-J., J.C.E., M.G.L., C.J.O., D.L.), Framingham, Mass; Cardiology Division (D.M.L.-J., C.J.O.), Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass; Division of Epidemiology and Preventive Medicine (J.C.E., M.G.L., D.L.), Boston University School of Medicine, Boston, Mass; National High Blood Pressure Education Program (E.J.R.), National Heart, Lung, and Blood Institute, Bethesda, Md; and Department of Medicine (D.L.), Beth Israel-Deaconess Medical Center, Harvard Medical School, Boston, Mass.
Correspondence to Daniel Levy, MD, Framingham Heart Study, 5 Thurber St, Framingham, MA 01702. E-mail dan{at}fram.nhlbi.nih.gov
Abstract—Data from the Third
National Health and Nutrition Examination Survey, phase 2 (1991 to
1994), indicate that among hypertensive individuals in the United
States, 53.6% are treated and only 27.4% are controlled to goal
levels. We sought to determine whether poor hypertension control is due
to lack of systolic or diastolic blood pressure
control, or both. We studied Framingham Heart Study participants
examined between 1990 and 1995 and determined rates of control to
systolic goal (<140 mm Hg), diastolic goal
(<90 mm Hg), or both (systolic <140 and
diastolic <90 mm Hg). Of 1959 hypertensive subjects
(mean age 66 years, 54% women), 32.7% were controlled to
systolic goal, 82.9% were controlled to diastolic
goal, and only 29.0% were controlled to both. Among the 1189 subjects
who were receiving antihypertensive therapy (60.7% of all hypertensive
subjects), 49.0% were controlled to systolic goal, 89.7% were
controlled to diastolic goal, and only 47.8% were
controlled to both. Thus, poor systolic blood pressure control
was overwhelmingly responsible for poor rates of overall control to
goal. Covariates associated with lack of systolic control in
treated subjects included older age (OR for age 61 to 75 years, 2.43,
95% CI 1.79 to 3.29; OR for age >75 years, 4.34, 95% CI 3.10 to
6.09), left ventricular hypertrophy (OR 1.63,
95% CI 1.04 to 2.54), and obesity (OR for body mass index 
30 versus
<25 kg/m2, 1.49, 95% CI 1.08 to 2.06). In this
community-based sample of middle-aged and older subjects, overall rates
of hypertension control were remarkably similar to those in the Third
National Health and Nutrition Examination Survey. Poor blood pressure
control was overwhelmingly due to lack of systolic control,
even among treated subjects. Therefore, clinicians and policymakers
should place greater emphasis on the achievement of goal
systolic levels in all hypertensive patients, especially those
who are older or obese or have target organ damage.
Key Words: hypertension detection and control • blood pressure • epidemiology • antihypertensive therapy
This article has been cited by other articles:
 |
|
 |
|
  J. Basile Blood pressure responder rates versus goal rates: which metric matters? Therapeutic Advances in Cardiovascular Disease, April 1, 2009; 3(2): 157 - 174. [Abstract] [PDF]
|
|
|
|
 |
|
 B. Williams The aorta and resistant hypertension. J. Am. Coll. Cardiol., February 3, 2009; 53(5): 452 - 454. [Full Text] [PDF]
|
|
|
|
 |
|
 H. Kobori, A. B. Alper Jr, R. Shenava, A. Katsurada, T. Saito, N. Ohashi, M. Urushihara, K. Miyata, R. Satou, L. L. Hamm, et al. Urinary Angiotensinogen as a Novel Biomarker of the Intrarenal Renin-Angiotensin System Status in Hypertensive Patients Hypertension, February 1, 2009; 53(2): 344 - 350. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. B. Kannel and P. A. Wolf Framingham Study Insights on the Hazards of Elevated Blood Pressure JAMA, December 3, 2008; 300(21): 2545 - 2547. [Full Text] [PDF]
|
|
|
|
 |
|
 D. A. Calhoun, D. Jones, S. Textor, D. C. Goff, T. P. Murphy, R. D. Toto, A. White, W. C. Cushman, W. White, D. Sica, et al. 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 Circulation, June 24, 2008; 117(25): e510 - e526. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. A. Calhoun, D. Jones, S. Textor, D. C. Goff, T. P. Murphy, R. D. Toto, A. White, W. C. Cushman, W. White, D. Sica, et al. 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, June 1, 2008; 51(6): 1403 - 1419. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. Biaggioni Should We Target the Sympathetic Nervous System in the Treatment of Obesity-Associated Hypertension? Hypertension, February 1, 2008; 51(2): 168 - 171. [Full Text] [PDF]
|
|
|
|
 |
|
 D. A. Calhoun Aldosteronism and Hypertension Clin. J. Am. Soc. Nephrol., September 1, 2006; 1(5): 1039 - 1045. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. L. Roumie, T. A. Elasy, R. Greevy, M. R. Griffin, X. Liu, W. J. Stone, K. A. Wallston, R. S. Dittus, V. Alvarez, J. Cobb, et al. Improving blood pressure control through provider education, provider alerts, and patient education: a cluster randomized trial. Ann Intern Med, August 1, 2006; 145(3): 165 - 175. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Assmann, P. Cullen, T. Evers, D. Petzinna, and H. Schulte Importance of arterial pulse pressure as a predictor of coronary heart disease risk in PROCAM Eur. Heart J., October 2, 2005; 26(20): 2120 - 2126. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. J. Wang and R. S. Vasan Epidemiology of Uncontrolled Hypertension in the United States Circulation, September 13, 2005; 112(11): 1651 - 1662. [Full Text] [PDF]
|
|
|
|
|
|
D. M. Lloyd-Jones, J. C. Evans, and D. Levy Hypertension in Adults Across the Age Spectrum: Current Outcomes and Control in the Community JAMA, July 27, 2005; 294(4): 466 - 472. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. A. Peralta, L. S. Hicks, G. M. Chertow, J. Z. Ayanian, E. Vittinghoff, F. Lin, and M. G. Shlipak Control of Hypertension in Adults With Chronic Kidney Disease in the United States Hypertension, June 1, 2005; 45(6): 1119 - 1124. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Verdecchia and F. Angeli Natural History of Hypertension Subtypes Circulation, March 8, 2005; 111(9): 1094 - 1096. [Full Text] [PDF]
|
|
|
|
 |
|
 J. Amar, J. P. Cambou, E. Touze, V. Bongard, G. Jullien, A. Vahanian, G. Coppe, J. L. Mas, and on behalf of ECLAT1 Study Investigators Comparison of Hypertension Management After Stroke and Myocardial Infarction: Results From ECLAT1--A French Nationwide Study Stroke, July 1, 2004; 35(7): 1579 - 1583. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Wolf-Maier, R. S. Cooper, H. Kramer, J. R. Banegas, S. Giampaoli, M. R. Joffres, N. Poulter, P. Primatesta, B. Stegmayr, and M. Thamm Hypertension Treatment and Control in Five European Countries, Canada, and the United States Hypertension, January 1, 2004; 43(1): 10 - 17. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. G Friedrich, B. Dahlof, U. Sechtem, T. Unger, M. Knecht, R. Dietz, and TELMAR Investigators Telmisartan Effectiveness on Left ventricular MAss Reduction (TELMAR) as assessed by magnetic resonance imaging in patients with mild-to-moderate hypertension -- a prospective, randomised, double-blind comparison of telmisartan with metoprolol over a period of six months -- rationale and study design Journal of Renin-Angiotensin-Aldosterone System, December 1, 2003; 4(4): 234 - 243. [Abstract] [PDF]
|
|
|
|
|
|
A. V. Chobanian, G. L. Bakris, H. R. Black, W. C. Cushman, L. A. Green, J. L. Izzo Jr, D. W. Jones, B. J. Materson, S. Oparil, J. T. Wright Jr, et al. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure Hypertension, December 1, 2003; 42(6): 1206 - 1252. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. M. Humma and P. L. Adenekan Response to renin-angiotensin system antagonists in hypertensive black subjects J. Am. Coll. Cardiol., September 17, 2003; 42(6): 1141 - 1141. [Full Text] [PDF]
|
|
|
|
|
|
I. Hajjar and T. A. Kotchen Trends in Prevalence, Awareness, Treatment, and Control of Hypertension in the United States, 1988-2000 JAMA, July 9, 2003; 290(2): 199 - 206. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Pellegrini, M. Belfiglio, G. De Berardis, M. Franciosi, B. Di Nardo, S. Greenfield, S. H. Kaplan, M. Sacco, G. Tognoni, M. Valentini, et al. Role of Organizational Factors in Poor Blood Pressure Control in Patients With Type 2 Diabetes: The QuED Study Group--Quality of Care and Outcomes in Type 2 Diabetes Arch Intern Med, February 24, 2003; 163(4): 473 - 480. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J Amar, B Chamontin, J Ferrieres, N Danchin, O Grenier, C Cantet, and J-P Cambou Hypertension control at hospital discharge after acute coronary event: influence on cardiovascular prognosis--the PREVENIR study Heart, December 1, 2002; 88(6): 587 - 591. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. M. Lloyd-Jones, J. C. Evans, M. G. Larson, and D. Levy Treatment and Control of Hypertension in the Community: A Prospective Analysis Hypertension, November 1, 2002; 40(5): 640 - 646. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. W. Hense, W. Maziak, and J. Heidrich Why is blood pressure control unsatisfactory--or is it? Nephrol. Dial. Transplant., September 1, 2002; 17(9): 1547 - 1550. [Full Text] [PDF]
|
|
|
|
 |
|
 J. P. Whisnant, D. O. Wiebers, W. M. O'Fallon, J. D. Sicks, and R. L. Frye Effect of time since onset of risk factors on the occurrence of ischemic stroke Neurology, March 12, 2002; 58(5): 787 - 794. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. S. Vasan, A. Beiser, S. Seshadri, M. G. Larson, W. B. Kannel, R. B. D'Agostino, and D. Levy Residual Lifetime Risk for Developing Hypertension in Middle-aged Women and Men: The Framingham Heart Study JAMA, February 27, 2002; 287(8): 1003 - 1010. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Aviv Hypothesis : Pulse Pressure and Human Longevity Hypertension, April 1, 2001; 37(4): 1060 - 1066. [Abstract] [Full Text] [PDF]
|
|