Response to Nonpharmacological Treatment of Hypertension: Impact on Prevalence Estimates
We reported previously on the prevalence, awareness, treatment, and control of hypertension in the United States, using data from the National Health and Nutrition Examination Survey 1999–2004.1 Mellen and Goff2 commented that the definition of hypertension that we used underestimated the prevalence of hypertension in the US population, because we did not include participants who had been told previously on 2 or more occasions by a physician that they have hypertension but whose blood pressure became normal without taking medications, perhaps because of lifestyle changes. We appreciate their perceptive comments. Their operational definition of hypertension was used by Fields et al3 but not by Hajjar et al.4 Whether or not to include former diagnosis of hypertension is debatable.5 To some extent, it depends on whether essential hypertension is viewed as curable or incurable.
Our approach identifies those who need treatment, that is, those who have uncontrolled blood pressure or those taking antihypertensive medication. Therefore, we have classified those participants who have been successfully treated with nonpharmacological interventions as normotensive, 35.9±3.7% of whom have been told to take antihypertensive medication before. If we use the definition by Mellen and Goff,2 the unadjusted prevalence of hypertension would become 29.7±1.4%, 29.0±1.1%, and 32.7±1.2% in 1999–2000, 2001–2002, and 2003–2004, respectively. The corresponding age-adjusted prevalences were 31.5±1.3%, 30.8±1.0%, and 33.0±1.0%, respectively. Using the definition by Mellen and Goff,2 the unadjusted control rates among all hypertensive patients were 35.4±2.1%, 39.1±1.0%, and 42.8±2.3% in 1999–2000, 2001–2002, and 2003–2004, respectively. The corresponding age-adjusted control rates were 36.8±2.9%, 43.3±1.6%, and 45.7±3.0%, respectively. Whichever definition of hypertension is used, there was no significant change in the prevalence of hypertension (P>0.05), but there was a significant increase in blood pressure control in patients with hypertension from 1999–2000 to 2003–2004 (P<0.03).
Ong KL, Cheung BMY, Man YB, Lau CP, Lam KSL. Prevalence, awareness, treatment, and control of hypertension among United States adults 1999–2004. Hypertension. 2007; 49: 69–75.
Mellen PB, Goff DC Jr. Nonpharmacological treatment of hypertension: impact on prevalence estimates. Hypertension. 2007; 50: e1.
Fields LE, Burt VL, Cutler JA, Hughes J, Roccella EJ, Sorlie P. The burden of adult hypertension in the United States 1999 to 2000: a rising tide. Hypertension. 2004; 44: 398–404.
Wang TJ, Vasan RS. Epidemiology of uncontrolled hypertension in the United States. Circulation. 2005; 112: 1651–1662.