Published online before print December 11, 2006, doi: 10.1161/01.HYP.0000252676.46043.18
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(Hypertension. 2007;49:69.)
© 2007 American Heart Association, Inc.
Original Articles |
Prevalence, Awareness, Treatment, and Control of Hypertension Among United States Adults 1999–2004
From the Department of Medicine and the Research Centre of Heart, Brain, Hormone and Healthy Aging, University of Hong Kong, Hong Kong.
Correspondence to Bernard M. Y. Cheung, University Department of Medicine, Queen Mary Hospital, Pokfulam, Hong Kong. E-mail mycheung{at}hkucc.hku.hk
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Abstract |
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Detection of hypertension and blood pressure control are critically important for reducing the risk of heart attacks and strokes. We analyzed the trends in the prevalence, awareness, treatment, and control of hypertension in the United States in the period 1999–2004. We used the National Health and Nutrition Examination Survey 1999–2004 database. Blood pressure information on 14 653 individuals (4749 in 1999–2000, 5032 in 2001–2002, and 4872 in 2003–2004) aged
18 years was used. Hypertension was defined as blood pressure 140/90 mm Hg or taking antihypertensive medications. The prevalence of hypertension in 2003–2004 was 7.3±0.9%, 32.6±2.0%, and 66.3±1.8% in the 18 to 39, 40 to 59, and 60 age groups, respectively. The overall prevalence was 29.3%. When compared with 1999–2000, there were nonsignificant increases in the overall prevalence, awareness, and treatment rates of hypertension. The blood pressure control rate was 29.2±2.3% in 1999–2000 and 36.8±2.3% in 2003–2004. The age-adjusted increase in control rate was 8.1% (95% CI: 2.4 to 13.8%; P=0.006). The control rates increased significantly in both sexes, non-Hispanic blacks, and Mexican Americans. Among the 60 age group, the awareness, treatment, and control rates of hypertension had all increased significantly (P
0.01). The improvement in blood pressure control is encouraging, although the prevalence of hypertension has not declined.
Key Words: hypertension • United States • prevalence • awareness • control
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Introduction |
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Hypertension affects
65 million adult Americans1 and is a major risk factor for myocardial infarction, stroke, heart failure, and renal failure. The control of blood pressure (BP) is crucial in the prevention of these adverse outcomes. However, hypertension can be asymptomatic, so many people with hypertension do not see a doctor. The detection and control of BP is, thus, a major public health challenge in the United States. The National Health and Nutrition Examination Survey (NHANES)2 is a large health and nutritional survey of the civilian noninstitutionalized population of the United States and is very useful for monitoring trends in the health status of the population that arise as a result of public health measures or changes in clinical practice. In NHANES 1999–2000, 28.7% of people had hypertension. A total of 68.9% of people with hypertension were aware of the diagnosis, 58.4% received treatment, and only in 31.0% was the BP controlled.3 We reported previously a nonsignificant trend of improvement in the BP control rate among people with hypertension in the period 1999–2002.4 Moreover, the BP goal for hypertensive patients with diabetes has changed from 130/85 mm Hg to 130/80 mm Hg.5 Data from the NHANES study conducted in 2003–2004 have recently become available. Here, we analyzed the trends in the prevalence, awareness, treatment, and control of hypertension in the United States in the period 1999–2004 to ascertain whether there are further improvements in hypertension control according to the current treatment goals. |
Methods |
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NHANES was conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention.2 A stratified, multistage probability sampling design was used in the survey. The detailed measurement procedures and protocols have been described in previous publications and also on its website.6–8 Since 1999, NHANES has become a continuous survey program. The 1999–2004 results are available online. All of the participants gave informed consent, and the study received approval from the Centers for Disease Control and Prevention Institutional Review Board.
BP was measured 3 or 4 times manually by a trained operator using a mercury sphygmomanometer according to a standard protocol and calculated as the average after excluding the first measurement.9 The BP measurement techniques were identical over the 3 periods (1999–2000, 2001–2002, and 2003–2004). Body mass index (BMI) was calculated as weight in kilograms divided by the square of height in meters. Individuals aged 18 years were included in the analysis (n=17 061). Participants who were interviewed but not examined were excluded from analysis (n=1190). Those with missing data on BP or BMI were also excluded (n=1218).
Hypertension was defined as an average BP 140/90 mm Hg or if the participant was taking antihypertensive medications. The same BP criteria applied to diabetic participants. Participants who had been diagnosed to have hypertension were considered to be aware of their hypertension. Participants were considered to be treated if they were taking antihypertensive drugs. Hypertension was considered controlled in those on treatment if the average BP was <140/90 mm Hg in nondiabetic patients. Participants were considered to have diabetes if it had been diagnosed previously by a doctor or if they were receiving insulin or oral diabetic medications. For diabetic participants, hypertension was considered to be controlled if the average BP was <130/80 mm Hg.5
Data were analyzed using the complex sample function of SPSS (version 13.0). Sampling errors were estimated using the primary sampling units and strata provided in the data set. Sampling weights were used to adjust for nonresponse bias and the oversampling of blacks, Mexican Americans, and the elderly in NHANES. The prevalence of hypertension, as well as the awareness, treatment, and control rates, were age adjusted by direct standardization to the US 2000 standard population.10 To analyze differences over time, the 2003–2004 data were compared with the 1999–2000 data. Estimates with a coefficient of variation >0.3 were considered unreliable. A 2-tailed P value <0.05 was considered statistically significant.
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Results |
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In this analysis, data on 14 653 individuals (4749 in 1999–2000, 5032 in 2001–2002, and 4872 in 2003–2004) were included. Table 1 shows the age, race/ethnicity, BMI, BP, and diabetic status of the US population estimated from NHANES 1999–2004. There was no overall significant difference in the mean age between 1999–2000 and 2003–2004. However, in 2003–2004, there were fewer people in the 18 to 39 age group and more people in the 40 to 59 age group. In 2003–2004, fewer US adults had not completed high school. There was a trend of decreasing BP levels, especially in the elderly. Among the
60 age group, the mean systolic and diastolic BPs had decreased significantly (P=0.006 and 0.003, respectively). It is interesting that weight and BMI did not increase significantly from 1999–2000 to 2003–2004. However, the waist circumference had increased, from 94.95±0.64 cm (37.4±0.3 in) in 1999–2000 to 95.43±0.34 cm (37.6±0.1 in) in 2001–2002 to 96.74±0.35 cm (38.1±0.1 in) in 2003–2004 (P=0.014).
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Table 2 shows the prevalence of hypertension in the United States. There was no significant change in the prevalence of hypertension, even in different age, sex, race/ethnicity, and BMI groups (P>0.05). The prevalence of hypertension was also analyzed by sex, race/ethnicity, and BMI in 18 to 39, 40 to 59, and 60 age groups, but the age-specific changes in sex, race/ethnicity, and BMI were not significant. In all 3 of the periods, the prevalence of hypertension increased with increasing age and BMI (P<0.001) but did not vary significantly with sex. Non-Hispanic blacks had the highest prevalence. To measure the independent association of these variables and education with hypertension, a multiple logistic regression using the data from NHANES 2003–2004 was performed with hypertension as the dependent variable. Increasing age, increasing BMI, being non-Hispanic black, and having less education were significantly associated with hypertension, whereas sex was not (Table 3).
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Table 4 shows the rates of awareness, treatment, and BP control. In 2003–2004, 75.7±2.1% of people with hypertension were aware of their diagnosis, 65.1±2.4% were treated, and 36.8±2.3% had BP controlled (56.6±2.4% among those treated). The age-adjusted awareness and treatment rates increased but not significantly since 1999–2000. There was also a nonsignificant increase in the control rate among treated hypertensive people. The proportion of treated hypertensive people with diabetes reaching the contemporary target of <130/80 mm Hg increased, although this was not statistically significant after age adjustment. However, the BP control rate among all people with hypertension increased significantly from 29.2±2.3% in 1999–2000 to 36.8±2.3% in 2003–2004 (P=0.02 and after age adjustment, P=0.006). The increase in age-adjusted BP control rate in this 6-year period was 8.1% (95% CI: 2.4 to 13.8%) in absolute terms.
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The Figure shows the age-specific prevalence of hypertension and BP control rates in different racial/ethnic groups. It shows the marked increase in the prevalence of hypertension with age and the significantly higher prevalence of hypertension in non-Hispanic blacks. The control rates were the lowest in middle-aged Mexican American women (27.8%) among all of the hypertensive people and in old non-Hispanic black women (39.8%) among those treated.
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P<0.01, 
P<0.001 for the difference within the same age group (non-Hispanic whites as the referent for race/ethnicity). Error bars indicate 95% CIs. The estimate for prevalence of hypertension in 2003–2004 among Mexican American women aged 18 to 39 years is unreliable because of coefficient of variation >0.3.
Table 5 shows the effects of sex and race/ethnicity on the awareness, treatment, and control of hypertension. Between 1999 and 2004, there were no significant changes in the awareness and treatment rates of hypertension by sex and race/ethnicity. There was also no significant change in the control rate among treated hypertensive people by sex and race/ethnicity. However, the control rate among all of the hypertensive people increased in both men and women (P=0.03 and 0.05, respectively). It improved significantly in non-Hispanic blacks and Mexican Americans (P=0.02 and 0.03, respectively). In Mexican American men, it increased from 8.7±2.2% in 1999–2000 to 31.1±7.0% in 2003–2004 (P=0.002), which was mainly because of the age-adjusted proportion on treatment increasing from 28.9±4.9% to 49.8±8.8% (P=0.04). Table 6 shows the effects of age and BMI on the awareness, treatment, and control of hypertension in 1999–2004. The awareness, treatment, and control rates of hypertension increased in the 60 age group (P0.01). In this elderly age group in 2003–2004, 81.0±2.0% were aware of their diagnosis, 73.4±2.1% received treatment, and BP was controlled in 36.7±1.9% (50.0±2.5% among those treated). In the 18- to 39-year age group, there was an increase in the control rate (P=0.04) but not in the awareness and treatment rates. In obese people with a BMI 30 kg/m2, there was an increase in the control rate (P=0.007). The unadjusted rates of awareness, treatment, and control of hypertension in different sex, race/ethnicity, age, and BMI groups are shown in Supplementary Tables I and II (available online at http://hyper.ahajournals.org).
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Discussion |
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The NHANES database has been valuable for the study of the trends in the health status of a population because of its large sample size, complex sampling design, good quality control, and comprehensive content.2 It has been used to study the prevalence, awareness, treatment, and control of hypertension in the United States.3,4,11–15 The data for 2003–2004 have just been released, and our analysis confirms previous observations and extends previous conclusions. The prevalence of hypertension has not increased significantly since 1999. At the same time, there has been increasing control rate of hypertension, especially in Mexican American men, elderly, and obese people. The lack of increased prevalence of hypertension may be because of the lack of a further increase in BMI in the population, although there was an increase in waist circumference. Better publicity and education and effort from health professionals may be another reason for this. The increase in BP control rates may be the result of clinical guidelines on the management of hypertension5 rather than improved antihypertensive drugs, because there were no new major antihypertensive drugs introduced in this period. Public health measures and intensified antihypertensive treatment seem to be effective in improving BP control rates. The latest hypertension management guidelines recommended the use of diuretics as first-line antihypertensive medications for uncomplicated hypertension and the use of multiple antihypertensive drugs to control BP.5,16 A recent report revealed an increase in the use of antihypertensive medications in men from NHANES III (1988–1994) and NHANES 1999–2002.17 Moreover, there was increasing use of angiotensin-converting enzyme inhibitor among hypertensive patients with diabetes, congestive heart failure, and heart attack.17 This was consistent with current guidelines.5,16 The use of diuretics also increased shortly after the release of new evidence on the clinical equivalence of diuretics to calcium channel blockers and angiotensin-converting enzyme inhibitors in December 2002.18,19 In recent years, it is recognized that most hypertensive patients require multiple antihypertensive drugs to control BP.20–23 The readiness to use multiple drugs may explain the increase in BP control rates in 1999–2004.
The awareness and control rates of hypertension were better in older people and people with higher BMI, whereas there was relative undertreatment of hypertensive people of younger age and lower BMI. This may be because of greater concerns in health status among older and obese people. The significant increase in waist circumference but not weight and BMI suggests an increasing trend of abdominal obesity. In fact, a detailed study of obesity in NHANES 1999–2004 revealed a significant increase in the prevalence of obesity among men but not women.24
Large clinical trials in hypertensive patients showed that BP reduction is crucial in reducing adverse cardiovascular outcomes.25–28 A small reduction in BP could reduce the risk of heart failure, stroke, and myocardial infarction markedly.5,29 The increased control rates and decreased mean BPs, especially among the elderly, may help to decrease the incidence of strokes and heart attacks, which is highly encouraging. Clinicians need to overcome clinical inertia and step up treatment to reach the BP target. Other than antihypertensive medication, lifestyle interventions should also be encouraged in hypertensive patients.30
According to the national goal of Healthy People 2010, the proportion of adults with high BP should be reduced to 16%, and the proportion of adults with high BP whose BP is under control should be reduced to 50%.31 It seems unlikely, because of the aging population, that the proportion of adults with hypertension can be reduced to 16%. However, the improvement in BP control rates in the last few years is highly encouraging, suggesting that, with concerted effort from health professionals and the government agencies, the target of 50% BP control rate may be reached by 2010. Recent clinical trials showed that a high BP control rate of 66% to 71% could be achieved in some settings and environments.22,23,32,33 Although we did not find a significant increase in the age-adjusted rate of BP control in patients under treatment, the age-adjusted rate was 63.9% in 2003–2004, close to the control rates of 70% to 80% found in clinical trials.22,23,32,33 The increase in age-adjusted control rates among treated hypertensive patients with diabetes from 15.7% to 33.2% is promising although not statistically significant, but this is still in need of substantial improvement. In 2003–2004, approximately one third of hypertensive patients were unaware of their hypertension, and our efforts to detect hypertension need to be improved. The treatment rate among hypertensive patients was only 53.7%. Therefore, approximately half of the hypertensive subjects were not being treated. To meet Healthy People 2010, the greatest attention must be paid to this group. In countries with limited resources like Cuba, very good BP control can be achieved through investment in the training of health professionals, availability of locally manufactured drugs, and more aggressive policy at the primary care level.34 Therefore, there is room for further improvement in the control of hypertension in the United States.
Studies using a BP goal of <140/90 mm Hg in hypertensive people with diabetes might overestimate BP control rates.1,3,4,13–15,35 Therefore, in this study, different control goals were used for those with and without diabetes to produce a more accurate control rate. However, there are some limitations in our study. The BP goal for hypertensive patients with diabetes was changed from <130/85 mm Hg to <130/80 mm Hg in 2003.5 Therefore, the BP control rates in people with diabetes might seem poor before 2003. Inaccuracies in estimating BP control rates in the diabetic population might also arise from not classifying diabetic people with prehypertension as hypertensive, although they may require antihypertensive medications to bring their BP to <130/80 mm Hg. The limited sample sizes for each 2-year period made the estimates in some subgroups less reliable and made it difficult to study interactions between factors such as age, sex, and race/ethnicity. Estimates of prevalence are substantially affected by age adjustment. The age distribution of the US general population, used for the adjustment standard, is much younger than the hypertensive population, so the adjustment emphasizes the estimates among the younger population. A better standard population might be the age distribution of those with hypertension, such as for the entire 1999–2004 period.
Perspectives
Our study indicated that there was no significant change in the prevalence of hypertension in the US population in the period 1999–2004. However, there were significant improvements in the control rates, especially in the elderly. These findings suggest that public health measures or changes in clinical practice are in the right direction.
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Acknowledgments |
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Disclosures
None.
Received June 14, 2006; first decision July 12, 2006; accepted October 8, 2006.
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 L. N. Borrell Race, Ethnicity, and Self-Reported Hypertension: Analysis of Data From the National Health Interview Survey, 1997-2005 Am J Public Health, February 1, 2009; 99(2): 313 - 319. [Abstract] [Full Text] [PDF]
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 A. Schoenthaler, G. Ogedegbe, and J. P. Allegrante Self-Efficacy Mediates the Relationship Between Depressive Symptoms and Medication Adherence Among Hypertensive African Americans Health Educ Behav, February 1, 2009; 36(1): 127 - 137. [Abstract] [PDF]
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 M. McDonald, R. P. Hertz, A. N. Unger, and M. B. Lustik Prevalence, Awareness, and Management of Hypertension, Dyslipidemia, and Diabetes Among United States Adults Aged 65 and Older J Gerontol A Biol Sci Med Sci, February 1, 2009; 64A(2): 256 - 263. [Abstract] [Full Text] [PDF]
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WRITING GROUP MEMBERS, D. Lloyd-Jones, R. Adams, M. Carnethon, G. De Simone, T. B. Ferguson, K. Flegal, E. Ford, K. Furie, A. Go, et al. Heart Disease and Stroke Statistics--2009 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Circulation, January 27, 2009; 119(3): e21 - e181. [Full Text] [PDF]
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 J. B. McGill Reexamining Misconceptions About {beta}-Blockers in Patients With Diabetes Clin. Diabetes, January 1, 2009; 27(1): 36 - 46. [Abstract] [Full Text] [PDF]
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R. C. Gwynn, R. K. Garg, B. D. Kerker, T. R. Frieden, and L. E. Thorpe Contributions of a Local Health Examination Survey to the Surveillance of Chronic and Infectious Diseases in New York City Am J Public Health, January 1, 2009; 99(1): 152 - 159. [Abstract] [Full Text] [PDF]
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Y. Wu, R. Huxley, L. Li, V. Anna, G. Xie, C. Yao, M. Woodward, X. Li, J. Chalmers, R. Gao, et al. Prevalence, Awareness, Treatment, and Control of Hypertension in China: Data from the China National Nutrition and Health Survey 2002 Circulation, December 16, 2008; 118(25): 2679 - 2686. [Abstract] [Full Text] [PDF]
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 P. A. Sarafidis and G. L. Bakris Resistant Hypertension An Overview of Evaluation and Treatment. J. Am. Coll. Cardiol., November 25, 2008; 52(22): 1749 - 1757. [Abstract] [Full Text] [PDF]
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 J. H. Jackson, J. Sobolski, R. Krienke, K. S. Wong, F. Frech-Tamas, and B. Nightengale Blood Pressure Control and Pharmacotherapy Patterns in the United States Before and After the Release of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) Guidelines J Am Board Fam Med, November 1, 2008; 21(6): 512 - 521. [Abstract] [Full Text] [PDF]
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 K. Fiscella and K. Holt Racial Disparity in Hypertension Control: Tallying the Death Toll Ann. Fam. Med, November 1, 2008; 6(6): 497 - 502. [Abstract] [Full Text] [PDF]
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 P. D. Chantler, E. G. Lakatta, and S. S. Najjar Arterial-ventricular coupling: mechanistic insights into cardiovascular performance at rest and during exercise J Appl Physiol, October 1, 2008; 105(4): 1342 - 1351. [Abstract] [Full Text] [PDF]
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 S. Aronson, C. M. Dyke, K. A. Stierer, J. H. Levy, A. T. Cheung, P. D. Lumb, D. J. Kereiakes, and M. F. Newman The ECLIPSE Trials: Comparative Studies of Clevidipine to Nitroglycerin, Sodium Nitroprusside, and Nicardipine for Acute Hypertension Treatment in Cardiac Surgery Patients Anesth. Analg., October 1, 2008; 107(4): 1110 - 1121. [Abstract] [Full Text] [PDF]
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 S. Y. Angell, R. K. Garg, R. C. Gwynn, L. Bash, L. E. Thorpe, and T. R. Frieden Prevalence, Awareness, Treatment, and Predictors of Control of Hypertension in New York City Circ Cardiovasc Qual Outcomes, September 1, 2008; 1(1): 46 - 53. [Abstract] [Full Text] [PDF]
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 B. M.Y. Cheung, N. M.S. Wat, A. W.K. Tso, S. Tam, G. N. Thomas, G. M. Leung, H. F. Tse, J. Woo, E. D. Janus, C. P. Lau, et al. Association Between Raised Blood Pressure and Dysglycemia in Hong Kong Chinese Diabetes Care, September 1, 2008; 31(9): 1889 - 1891. [Abstract] [Full Text] [PDF]
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A. J. Viera, L. W. Cohen, C. M. Mitchell, and P. D. Sloane High Blood Pressure Knowledge Among Primary Care Patients with Known Hypertension: A North Carolina Family Medicine Research Network (NC-FM-RN) Study J Am Board Fam Med, July 1, 2008; 21(4): 300 - 308. [Abstract] [Full Text] [PDF]
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C. S. Fox and P. Muntner Trends in Diabetes, High Cholesterol, and Hypertension in Chronic Kidney Disease Among U.S. Adults: 1988-1994 to 1999-2004 Diabetes Care, July 1, 2008; 31(7): 1337 - 1342. [Abstract] [Full Text] [PDF]
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T. G. Pickering, N. H. Miller, G. Ogedegbe, L. R. Krakoff, N. T. Artinian, and D. Goff Call to Action on Use and Reimbursement for Home Blood Pressure Monitoring: A Joint Scientific Statement From the American Heart Association, American Society of Hypertension, and Preventive Cardiovascular Nurses Association Hypertension, July 1, 2008; 52(1): 10 - 29. [Abstract] [Full Text] [PDF]
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R. G. Victor, D. Leonard, P. Hess, D. G. Bhat, J. Jones, P. A. C. Vaeth, J. Ravenell, A. Freeman, R. P. Wilson, and R. W. Haley Factors Associated With Hypertension Awareness, Treatment, and Control in Dallas County, Texas Arch Intern Med, June 23, 2008; 168(12): 1285 - 1293. [Abstract] [Full Text] [PDF]
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 F. H.H. Leenen MD PhD, J. Dumais MSc, N. H. McInnis MSc, P. Turton BSc, L. Stratychuk MA, K. Nemeth MSc, M. Moy Lum-Kwong MBA, and G. Fodor MD PhD Results of the Ontario Survey on the Prevalence and Control of Hypertension Can. Med. Assoc. J., May 20, 2008; 178(11): 1441 - 1449. [Abstract] [Full Text] [PDF]
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S. Mohan MD MPH and N. R.C. Campbell MD Hypertension management in Canada: good news, but important challenges remain Can. Med. Assoc. J., May 20, 2008; 178(11): 1458 - 1460. [Full Text] [PDF]
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L. S. Phillips and J. G. Twombly It's Time to Overcome Clinical Inertia Ann Intern Med, May 20, 2008; 148(10): 783 - 785. [Full Text] [PDF]
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P. Gratze, R. Dechend, C. Stocker, J.-K. Park, S. Feldt, E. Shagdarsuren, M. Wellner, F. Gueler, S. Rong, V. Gross, et al. Novel Role for Inhibitor of Differentiation 2 in the Genesis of Angiotensin II-Induced Hypertension Circulation, May 20, 2008; 117(20): 2645 - 2656. [Abstract] [Full Text] [PDF]
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 D. G. Romero, M. W. Plonczynski, C. A. Carvajal, E. P. Gomez-Sanchez, and C. E. Gomez-Sanchez Microribonucleic Acid-21 Increases Aldosterone Secretion and Proliferation in H295R Human Adrenocortical Cells Endocrinology, May 1, 2008; 149(5): 2477 - 2483. [Abstract] [Full Text] [PDF]
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J. Ma and R. S. Stafford Screening, Treatment, and Control of Hypertension in US Private Physician Offices, 2003-2004 Hypertension, May 1, 2008; 51(5): 1275 - 1281. [Abstract] [Full Text] [PDF]
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 S. M. Grundy Metabolic Syndrome Pandemic Arterioscler. Thromb. Vasc. Biol., April 1, 2008; 28(4): 629 - 636. [Abstract] [Full Text] [PDF]
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K. R. Bailey, B. R. Grossardt, and J. W. Graves Novel Use of Kaplan-Meier Methods to Explain Age and Gender Differences in Hypertension Control Rates Hypertension, April 1, 2008; 51(4): 841 - 847. [Abstract] [Full Text] [PDF]
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K. L. Ong, A. W.K. Tso, K. S.L. Lam, and B. M.Y. Cheung Gender Difference in Blood Pressure Control and Cardiovascular Risk Factors in Americans With Diagnosed Hypertension Hypertension, April 1, 2008; 51(4): 1142 - 1148. [Abstract] [Full Text] [PDF]
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S. B. Wyatt, E. L. Akylbekova, M. R. Wofford, S. A. Coady, E. R. Walker, M. E. Andrew, W. J. Keahey, H. A. Taylor, and D. W. Jones Prevalence, Awareness, Treatment, and Control of Hypertension in the Jackson Heart Study Hypertension, March 1, 2008; 51(3): 650 - 656. [Abstract] [Full Text] [PDF]
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 T. R. Frieden and F. Mostashari Health Care as If Health Mattered JAMA, February 27, 2008; 299(8): 950 - 952. [Full Text] [PDF]
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L. H. Curtis, D. J. Whellan, B. G. Hammill, A. F. Hernandez, K. J. Anstrom, A. M. Shea, and K. A. Schulman Incidence and Prevalence of Heart Failure in Elderly Persons, 1994-2003 Arch Intern Med, February 25, 2008; 168(4): 418 - 424. [Abstract] [Full Text] [PDF]
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G. A. Mensah Public Health and the Control of High Blood Pressure at the State Level: Asleep at the Switch or Running Low on Fuel? Circulation, February 19, 2008; 117(7): 860 - 862. [Full Text] [PDF]
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 D. Weycker, J. Edelsberg, G. Vincze, D. G. Levy, A. Kartashov, and G. Oster Blood Pressure Control in Patients Initiating Antihypertensive Therapy Ann. Pharmacother., February 1, 2008; 42(2): 169 - 176. [Abstract] [Full Text] [PDF]
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Writing Group Members, W. Rosamond, K. Flegal, K. Furie, A. Go, K. Greenlund, N. Haase, S. M. Hailpern, M. Ho, V. Howard, et al. Heart Disease and Stroke Statistics--2008 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Circulation, January 29, 2008; 117(4): e25 - e146. [Full Text] [PDF]
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L. M. Brewster, K. Stronks, A. H. Zwinderman, and G. A. van Montfrans Creatine Kinase and the Correlates of Blood Pressure in a Random Population Sample Hypertension, January 1, 2008; 51(1): e4 - e5. [Full Text] [PDF]
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N. D. Wong, V. A. Lopez, G. L'Italien, R. Chen, S. E. J. Kline, and S. S. Franklin Inadequate Control of Hypertension in US Adults With Cardiovascular Disease Comorbidities in 2003-2004 Arch Intern Med, December 10, 2007; 167(22): 2431 - 2436. [Abstract] [Full Text] [PDF]
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J. Coresh, E. Selvin, L. A. Stevens, J. Manzi, J. W. Kusek, P. Eggers, F. Van Lente, and A. S. Levey Prevalence of Chronic Kidney Disease in the United States JAMA, November 7, 2007; 298(17): 2038 - 2047. [Abstract] [Full Text] [PDF]
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K. L. Margolis, L. B. Piller, C. E. Ford, M. A. Henriquez, W. C. Cushman, P. T. Einhorn, P. J. Colon Sr, D. G. Vidt, R. Christian, N. D. Wong, et al. Blood Pressure Control in Hispanics in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial Hypertension, November 1, 2007; 50(5): 854 - 861. [Abstract] [Full Text] [PDF]
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P. Margozzini, A. Rigotti, C. Ferreccio, N. Quezada, M. Garrido, and G. Valdes Review: Hypertension and the cardiometabolic syndrome in Chile: a review of concepts and consequences for the developing world Therapeutic Advances in Cardiovascular Disease, October 1, 2007; 1(1): 83 - 90. [Abstract] [PDF]
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 A. M. Davis, L. M. Vinci, T. M. Okwuosa, A. R. Chase, and E. S. Huang Cardiovascular Health Disparities: A Systematic Review of Health Care Interventions Med Care Res Rev, October 1, 2007; 64(5_suppl): 29S - 100S. [Abstract] [PDF]
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A. V. Chobanian Isolated Systolic Hypertension in the Elderly N. Engl. J. Med., August 23, 2007; 357(8): 789 - 796. [Full Text] [PDF]
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P. B. Mellen and D. C. Goff Jr Nonpharmacological Treatment of Hypertension: Impact on Prevalence Estimates Hypertension, July 1, 2007; 50(1): e1 - e1. [Full Text] [PDF]
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K. L. Ong and B. M.Y. Cheung Response to Nonpharmacological Treatment of Hypertension: Impact on Prevalence Estimates Hypertension, July 1, 2007; 50(1): e2 - e2. [Full Text] [PDF]
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P. L. Hess, J. S. Reingold, J. Jones, M. A. Fellman, P. Knowles, J. E. Ravenell, S. Kim, J. Raju, E. Ruger, S. Clark, et al. Barbershops as Hypertension Detection, Referral, and Follow-Up Centers for Black Men Hypertension, May 1, 2007; 49(5): 1040 - 1046. [Abstract] [Full Text] [PDF]
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 U.S. Hypertension Trends, 1999-2004 Journal Watch Cardiology, January 24, 2007; 2007(124): 4 - 4. [Full Text]
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T. A. Kotchen Hypertension Control: Trends, Approaches, and Goals Hypertension, January 1, 2007; 49(1): 19 - 20. [Full Text] [PDF]
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