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The Cardiovascular Health Study

Bruce M. Psaty, MD, PhD; Teri A. Manolio, MD, PhD; Nicholas L. Smith, PhD; Susan R. Heckbert, MD, PhD; John S. Gottdiener, MD; Gregory L. Burke, MD, MS; Joel Weissfeld, MD; Paul Enright, MD; Thomas Lumley, PhD; Neil Powe, MD, MPH, MBA; Curt D. Furberg, MD, PhD

Arch Intern Med. 2002;162:2325-2332.

Background  Control of high blood pressure (BP) in older adults is an important part of public health efforts at prevention.

Objective  To assess recent time trends in the awareness, treatment, and control of high BP and in the use of medications to treat high BP.

Methods  In the Cardiovascular Health Study, 5888 adults 65 years and older were recruited from 4 US centers. At baseline, participants underwent an extensive examination that included the measurement of BP, use of medications, and other risk factors. Participants were followed up with annual visits that assessed BP and medication use from baseline in 1989-1990 through the examination in 1998-1999. The primary outcome measures were control of BP to levels lower than than 140/90 mm Hg and the prevalence of use of various classes of antihypertensive medications.

Results  The awareness, treatment, and control of high BP improved during the 1990s. The proportions aware and treated were higher among blacks than whites, though control prevalences were similar. For both groups combined, the control of high BP to lower than 140/90 mm Hg increased from 37% at baseline to 49% in 1999. The 51% whose BP was not controlled generally had isolated mild to moderate elevations in systolic BP. Among treated persons, the improvement in control was achieved in part by a mean increase of 0.2 antihypertensive medications per person over the course of 9 years. Improved control was also achieved by increasing the proportion of the entire Cardiovascular Health Study population that was treated for hypertension, from 34.5% in 1990 to 51.1% in 1999. Time trends in antihypertensive drug use were pronounced. Among those without coronary disease, the use of low-dose diuretics and -blockers decreased, while the use of newer agents, such as calcium channel blockers, angiotensin-converting enzyme inhibitors, and -blockers increased.

Conclusions  While control of high BP improved in the 1990s, about half the participants with hypertension had uncontrolled BP, primarily mild to moderate elevations in systolic BP. Low-dose diuretics and -blockers—the preferred agents since 1993 according to the recommendations of the Joint National Committee on the Detection, Evaluation and Treatment of High Blood Pressure—remained underused. More widespread use of these agents will be an important intervention to prevent the devastating complications of hypertension, including stroke, myocardial infarction, and heart failure.

From the Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services (Dr Psaty), Epidemiology (Drs Smith and Heckbert), and Biostatistics (Dr Lumley), University of Washington, Seattle; the Epidemiology and Biometry Program, Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, Md (Dr Manolio); St Francis Hospital, Roslyn, NY (Dr Gottdiener); Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC (Drs Burke and Furberg); Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pa (Dr Weissfeld); Respiratory Sciences, Tucson, Ariz (Dr Enright); and the Welch Center for Prevention, Epidemiology and Clinical Research, Department of Medicine, Johns Hopkins University, Baltimore, Md (Dr Powe).