 |
|
Factors Associated With Hypertension Control in the General Population of the United States
Jiang He, MD, PhD;
Paul Muntner, PhD;
Jing Chen, MD, MS;
Edward J. Roccella, PhD, MPH;
Richard H. Streiffer, MD;
Paul K. Whelton, MD, MSc
Arch Intern Med. 2002;162:1051-1058.
ABSTRACT
| |
Background Uncontrolled hypertension is the most common and important risk factor
for cardiovascular and renal disease. We studied factors associated with hypertension
control in the Third National Health and Nutrition Examination Survey.
Methods A total of 3077 non-Hispanic whites, 1742 non-Hispanic blacks, and 1067
Mexican Americans 18 years or older with hypertension were included in the
current analysis. Blood pressure was measured by trained observers by means
of a standard mercury sphygmomanometer, and controlled hypertension was defined
as a mean systolic/diastolic blood pressure less than 140/90 mm Hg.
Results Percentages of persons with controlled hypertension differed significantly
by ethnicity and sex: 19.2% and 28.7% for white men and women, 17.5% and 28.6%
for black men and women, and 12.7% and 18.0% for Mexican American men and
women, respectively. After adjustment for important covariables, percentages
of persons with controlled hypertension were significantly higher among persons
who were currently (odds ratio [OR] 2.39; 95% confidence interval [CI], 1.52-3.74)
or formerly (OR, 1.81; 95% CI, 1.12-2.93) married, had private health insurance
(OR, 1.59; 95% CI, 1.02-2.49), visited the same facility for their health
care (OR, 2.77; 95% CI, 1.88-4.09) or saw the same provider for their health
care (OR, 2.29; 95% CI, 1.74-3.02), had their blood pressure checked during
the preceding 6 months (OR, 8.00; 95% CI, 3.75-17.1) or 6 to 11 months (OR,
5.31; 2.51-11.2), and reported using lifestyle modification to control their
hypertension (OR, 6.02; 95% CI, 4.20-8.63).
Conclusion These data strongly suggest that access to a regular source of health
care and modification of lifestyle are important factors in the control of
hypertension in the community.
INTRODUCTION
HYPERTENSION IS an important public health challenge in the United States.
As many as 50 million Americans have hypertension, defined as a systolic blood
pressure (BP) of 140 mm Hg or more and/or diastolic BP of 90 mm Hg or more
and/or taking antihypertensive medication.1
More than $26.1 billion is spent annually for medications, office visits,
and laboratory tests related to treatment of hypertension in the United States.2 Observational epidemiologic studies have demonstrated
that hypertension is associated with an increased risk of coronary heart disease
(the leading cause of death in the United States), stroke (the third leading
cause of death), congestive heart failure, end-stage renal disease, and peripheral
vascular disease.3-6
Clinical trials have shown that lowering BP reduces the incidence of and mortality
from cardiovascular disease.7-8
The proportion of persons with hypertension who have their BP controlled
(defined as systolic/diastolic BP <160/95 mm Hg) has increased dramatically
during the past several decades.9 However,
percentages of persons with controlled hypertension defined as a systolic/diastolic
BP less than 140/90 mm Hg are still only 19% in men and 28% in women in the
US general population.10 More troublesome,
the increase in percentages of persons with controlled hypertension has lessened
in recent years, even though several new effective pharmacologic and nonpharmacologic
interventions have been introduced for lowering BP.11-12
Epidemiologic studies have examined the effects of socioeconomic status, health
care, and lifestyle factors on hypertension control.13-16
These studies have been conducted in hospitals, in managed care settings,
and among inner city minority groups.13-16
Data on factors associated with hypertension control in the general population
are sparse, although this information is critically important as a scientific
basis for developing strategies to enhance hypertension treatment and control
in the community.
We took advantage of the large representative sample of the US general
population studied in the Third National Health and Nutrition Examination
Survey (NHANES III) to examine the association between socioeconomic status,
health care, and lifestyle factors, and hypertension control. This article
updates previous findings10 on hypertension
control from NHANES III phase 1 participants and extends the focus to factors
related to hypertension control.
SUBJECTS AND METHODS
STUDY PARTICIPANTS
The NHANES III was conducted by the National Center for Health Statistics
from 1988 to 1994. Details of the study's design and methods have been published
elsewhere.17 In brief, the NHANES III used
a stratified multistage probability design to obtain a representative sample
of the civilian noninstitutionalized US general population.17
The design included oversampling of the very young, the elderly, non-Hispanic
blacks, and Mexican Americans to improve the precision of estimates in these
groups. A total of 19 618 persons 18 years and older participated in
an interview and 17 752 participated in a medical examination at a mobile
examination center or their home. The overall response rate for interview
was 85.6%, and for examination, 78.9%, in the NHANES III. Of this group, 6143
participants were identified as having hypertension at the examination on
the basis of the presence of an average systolic BP of 140 mm Hg or more and/or
diastolic BP of 90 mm Hg or more, or having a personal history of hypertension
and taking antihypertensive medication. Of them, 164 participants were excluded
from the current analysis because their self-reported race or ethnicity was
not non-Hispanic white, non-Hispanic black, or Mexican American. In addition,
93 participants were excluded because of a lack of a BP measurement. Therefore,
5886 participants, consisting of 3077 non-Hispanic whites, 1742 non-Hispanic
blacks, and 1067 Mexican Americans with hypertension, were included in the
current analysis. A total of 1254 NHANES III participants who had a self-reported
history of hypertension but did not meet the current definition of hypertension
(BP  140/90 mm Hg and/or taking antihypertensive medication11)
were not included in this analysis. Of them, 653 currently used lifestyle
modification intervention to control their BP.
MEASUREMENTS
The NHANES III data were obtained during a standardized home interview
and a subsequent physical examination at a mobile examination center. Information
on a wide variety of sociodemographic, medical history, nutritional history,
and health service questions, such as age, race/ethnicity, sex, education,
physical activity, history of smoking, hypertension, diabetes, and alcohol
consumption, and health service, were obtained during the participant's home
interview. A question on leisure-time physical activity, "Compared with most
[men/women] your age, would you say that you are more active, less active,
or about the same?" was asked. The interview included 5 questions related
to the diagnosis and treatment of hypertension.10, 17
Blood pressure was measured 3 times during the home interview and another
3 times at the mobile examination center by trained observers according to
a standard protocol.10 The BP for individual
participants was calculated as the average of all available systolic and diastolic
readings. Controlled hypertension was defined as systolic BP less than 140
mm Hg and diastolic BP less than 90 mm Hg. Body weight and height were measured
according to a standard protocol, and body mass index (calculated as weight
in kilograms divided by the square of height in meters) was used as an index
for obesity.
STATISTICAL ANALYSES
Percentage of persons with controlled hypertension was calculated, with
all study participants with hypertension (both pharmaceutically treated and
untreated) used as the denominator. All estimates were weighted to represent
the total civilian, noninstitutionalized US general population. Sampling weights
were adjusted to reduce bias from nonresponse at the interview stage. Standard
errors were calculated by a technique appropriate to the complex survey design
and estimation procedure.18 The proportions
(means) of hypertension control and socioeconomic, health care, and lifestyle
factors were calculated by race/ethnicity and tested by  2
statistics or weighted analysis of variance. Multiple logistic regression
analysis was used to explore the association between study factors and hypertension
control rates. The odds ratios and 95% confidence intervals for controlled
hypertension were calculated by race/ethnicity groups. Because of a relatively
high percentage of persons with controlled hypertension, odds ratios may be
an overestimate of relative risk in the present study. All statistical analyses
were performed with Stata software (Stata Corp, College Station, Tex).18
RESULTS
Socioeconomic, health care, and lifestyle characteristics of the study
participants by race/ethnicity are presented in Table 1. On average, non-Hispanic whites were more likely to have
graduated from high school, to have a household income of $20 000/y or
less, and to be more physically active, while non-Hispanic blacks were less
likely to be married and more likely to be current smokers. A majority of
the study participants had health insurance, visited the same health care
facility, and saw the same health care provider, although the percentage for
them was lower for Mexican Americans. Most study participants had their BP
measured during the preceding 6 months and more than half of non-Hispanic
whites and blacks were taking antihypertensive medication, although the proportions
were lower in Mexican Americans. Approximately half of the study participants
reported use of lifestyle modification as definitive or adjunctive therapy
for management of their hypertension. The most common lifestyle modification
interventions reported were dietary sodium reduction, weight loss, and exercise.
|
|
|
|
Table 1. Characteristics of 5886 Participants With Hypertension 18
Years or Older in the Third National Health and Nutrition Examination Survey,
1988-1994
|
|
|
In each race/ethnicity group, percentages of persons with controlled
hypertension were higher in women than in men (Figure 1). Overall, non-Hispanic white and black women had the highest
percentage of persons with controlled hypertension, while Mexican American
men had the lowest percentage. The pattern for hypertension control by age
was similar for each of the race/ethnicity groups, being greatest for those
45 to 64 years old and lowest for those 75 years or older (Figure 2).
|
|
|
|
Figure 1. Percentage of persons with controlled
hypertension (<140/90 mm Hg) among non-Hispanic white, non-Hispanic black,
and Mexican American men and women in the Third National Health and Nutrition
Examination Survey, 1988 through 1994.
|
|
|
|
|
|
|
Figure 2. Age-specific percentage of persons
with controlled hypertension (<140/90 mm Hg) among non-Hispanic whites,
non-Hispanic blacks, and Mexican Americans in the Third National Health and
Nutrition Examination Survey, 1988 through 1994.
|
|
|
Table 2 presents the percentage
of persons with controlled hypertension according to socioeconomic status,
health care, and lifestyle factors. The percentage was statistically significantly
higher in persons who were overweight, visited the same health care facility
or saw the same health care provider, had a recent BP measurement, or reported
using lifestyle modifications to control their hypertension among all 3 race/ethnicity
groups. The percentage was higher in persons who were currently or had been
formerly married in non-Hispanic whites and Mexican Americans. The percentage
was lower in current smokers among non-Hispanic blacks and lower in heavy
alcohol drinkers among non-Hispanic blacks and Mexican Americans. The percentage
was higher in persons who reported being less physically active or had private
health insurance among non-Hispanic whites and blacks.
|
|
|
|
Table 2. Percentage of Hypertensive Participants Whose Blood Pressure
Was Controlled According to Socioeconomic Status, Health Care, and Lifestyle
Factors in the Third National Health and Nutrition Examination Survey, 1988-1994
|
|
|
Table 3 shows age- and sex-adjusted
odds ratios of hypertension control associated with socioeconomic status,
health care, and lifestyle factors by race/ethnicity group. The findings were
consistent with univariate analysis presented in Table 2.
|
|
|
|
Table 3. Age- and Sex-Adjusted Odds Ratio and 95% Confidence Interval
of Hypertension Control Associated With Socioeconomic Status, Health Care,
and Lifestyle Factors in the Third National Health and Nutrition Examination
Survey, 1988-1994
|
|
|
In a combined analysis that including all study participants, adjustment
for education, income, cigarette smoking, alcohol consumption, physical activity,
and body weight, in addition to age, sex, and race/ethnicity, did not change
the results (Table 4). Participants
who were currently or had been formerly married, had private health insurance,
visited the same health care facility or saw the same health care provider,
had their BP checked during the preceding 6 months or 6 to 11 months, or used
a lifestyle modification intervention for hypertension management were more
likely to have their hypertension controlled.
|
|
|
|
Table 4. Multivariate* Adjusted Odds Ratio and 95% Confidence Interval
of Hypertension Control in the Third National Health and Nutrition Examination
Survey, 1988-1994
|
|
|
COMMENT
This population-based study extends our understanding of hypertension
control in the US general population in several important ways. First, the
findings confirm previous reports indicating that the overall rate of hypertension
control is low in the US general population.10, 15-16
Furthermore, percentages of persons with controlled hypertension are lower
in men than in women, and lower in those aged 75 years or older. Mexican Americans
have the lowest rates of hypertension control in every age and sex group.
This study also indicates that a regular source of health care is an important
predictor of hypertension control. In addition, this study suggests that lifestyle
modification is in common use by persons with hypertension and is associated
with a higher proportion of hypertension control in the US general population.
SOCIOECONOMIC STATUS
Socioeconomic status has been associated with access to health care
and hypertension control in several epidemiologic studies.15, 19-21
National Health Interview Surveys indicate that lower socioeconomic status
is associated with fewer visits to physicians' offices and with a lower likelihood
of having been screened for hypertension.20-21
Kotchen and colleagues15 studied socioeconomic
status and hypertension control in a random sample of African Americans living
in inner-city Milwaukee, Wis. Socioeconomic status was divided into high,
middle, and low categories on the basis of median residential rental of the
census blocks. Lower socioeconomic status was associated with lower access
to private health care and poor hypertension control in the study population.15 Lower education and household income was also associated
with poor BP control in the Atherosclerosis Risk in Communities Study.22 In the current study, neither education level nor
household income was associated with hypertension control. This may indicate
that many federal, state, and local public health interventions have been
effective in reaching the poor and groups with lower socioeconomic status.
HEALTH INSURANCE AND REGULAR SOURCE OF CARE
Several studies reported that lack of health insurance is associated
with poor hypertension control in inner-city minority groups.13, 23
The present study found that having government or private health care insurance
was associated with a significantly higher rate of hypertension control in
non-Hispanic blacks and that having private health care insurance was associated
with a higher rate of hypertension control in an overall analysis.
The present study indicated that hypertensive persons who visited the
same health care facility or had the same health care provider had a 2- to
5-fold higher odds of having their hypertension controlled. This finding was
consistent with experience in a case-control study conducted in 93 black or
Hispanic cases with severe, uncontrolled hypertension and 114 controls with
controlled hypertension who were seen in the New York City Hospital's emergency
department.13 In their study, Shea and colleagues13 found that severe, uncontrolled hypertension was
3.5-fold more common among persons who had no primary care physician after
adjustment for age, sex, race/ethnicity, education, smoking status, alcohol-related
problems, use of illicit drugs during the previous year, and lack of health
insurance.13
The present study also identified a strong and consistent association
between frequency of BP measurement and hypertension control. Participants
who had had their BP measured during the preceding 6 months were 6- to 13-fold
more likely to have their hypertension controlled than those whose BP had
not been measured for at least 1 year before the study. These findings suggest
that access to high-quality health care may be one of the most important factors
for hypertension control in the general population.
LIFESTYLE MODIFICATION INTERVENTION
The present study identified a strong association between lifestyle
modification intervention and hypertension control. Study participants who
used any lifestyle modification to lower their BP were 5- to 11-fold more
likely to have their hypertension controlled. Clinical trials have documented
that weight loss, sodium reduction, exercise, alcohol restriction, and potassium
supplementation reduce BP in persons with hypertension.11
Besides its BP-lowering effect, lifestyle modification may also lead to an
improvement in compliance with antihypertensive drug treatment recommendations
by actively involving persons in their health care.19
However, because of the cross-sectional design used in the current study,
it is not possible to rule out the possibility that the association noted
between lifestyle modification and control of hypertension resulted from selection
bias, ie, patients with severe hypertension being less likely to receive lifestyle
modification interventions. In addition, compliance with lifestyle modification
may also be an indicator of overall compliance with all advice and treatment.
Therefore, our findings do not provide evidence of a causal relationship between
lifestyle modification and hypertension control.
The present study suggests that about 40% to 53% of patients with hypertension
in the US general population were attempting to control their hypertension
by reducing their sodium intake, 27% to 34% by controlling their weight, and
11% to 13% by exercising. These may be slight underestimates, as they do not
include subjects who have successfully controlled their hypertension through
lifestyle modifications. We excluded 653 participants who were currently using
lifestyle modification intervention and whose BP was less than 140/90 mm Hg
because they did not meet the current definition of hypertension.11 These data indicated that lifestyle modification
interventions are in common use for treatment of hypertension in the US general
population.
In previous studies, current cigarette smoking and alcohol consumption
were associated with poor control of hypertension.19, 22
In the present investigation, current cigarette smoking was associated with
a slightly, but nonsignificantly, lower percentage of persons with controlled
hypertension. Heavy alcohol consumption was associated with lower percentages
of persons with controlled hypertension. The present study found that less
self-reported physical activity was associated with higher percentages of
persons with controlled hypertension in non-Hispanic blacks. However, this
association was no longer statistically significant after adjustment for other
important covariables. Our results also indicated that overweight was associated
with higher percentages of persons with controlled hypertension in non-Hispanic
whites and blacks. In the Atherosclerosis Risk in Communities Study, overweight
was associated with enhanced hypertension awareness and treatment in white
and African American participants.22 This finding
may reflect the fact that patients who were overweight may be monitored and
have their hypertension treated more aggressively because being overweight
is known to increase the risk of having hypertension and developing cardiovascular
disease.
The present study also indicated that marital status was associated
with hypertension control. Men and women who were currently or had been formerly
married had higher percentages of control of hypertension. Lack of social
support has been identified as a risk factor for poor compliance with antihypertensive
treatment and hypertension control in other studies.19
RACE/ETHNICITY DIFFERENCES
Although overall findings from this study are consistent across race/ethnicity
groups, several race/ethnicity differences are worth mentioning. The proportion
of married persons was much lower in non-Hispanic blacks compared with other
groups, and marital status was not associated with hypertension control in
this group. This might reflect the cultural differences among race/ethnicity
groups. Percentage of hypertensive patients who were reducing their dietary
intake of sodium was much higher in non-Hispanic blacks compared with other
race/ethnicity groups in our study. This might reflect the fact that physicians
were more likely to recommend sodium reduction in non-Hispanic blacks because
of perceptions that they were more sensitive to sodium reduction.
LIMITATIONS AND STRENGTHS
Because of our study's cross-sectional design, causal associations cannot
be established with certainty. Other limitations include the relative lack
of information regarding the participants' health care providers, the providers'
relationship to their patients, and the lack of information regarding patients'
knowledge and their attitude toward hypertension. In addition, "white-coat"
hypertension cannot be defined in the present study because ambulatory BP
measurements were not obtained.
Important strengths of this study include the fact that it was conducted
in a large representative sample of the US general population; that there
were a large number of hypertension participants in each major race/ethnicity
group, permitting race-specific analyses; that all the data were carefully
collected by a specially trained study staff using standard instruments; and
that 6 BP readings obtained at 2 separate visits were available for each of
the participants.
PUBLIC HEALTH IMPLICATIONS
Our findings have important public health implications. First, this
study indicates that the overall rate of hypertension control is unacceptably
low in the US general population. Improvement of hypertension control should
be a public health priority to reduce the burden of BP-related morbidity and
mortality in the United States. To achieve better rates of hypertension control
in communities, patients should have a regular source and same provider of
health care, and health care providers should check their patients' BP on
a regular basis. Finally, lifestyle modification should be recommended as
an important component of hypertension control in the general population.
AUTHOR INFORMATION
Accepted for publication October 2, 2001.
This study was supported in part by grant R01HL60300 from the National
Heart, Lung, and Blood Institute of the National Institutes of Health, Bethesda,
Md.
Corresponding author and reprints: Jiang He, MD, PhD, Department
of Epidemiology, Tulane University School of Public Health and Tropical Medicine,
1430 Tulane Ave SL18, New Orleans, LA 70112 (e-mail: jhe{at}tulane.edu).
From the Department of Epidemiology, Tulane University School of Public
Health and Tropical Medicine, New Orleans, La (Drs He, Muntner, and Whelton);
Departments of Medicine (Drs He, Chen, and Whelton) and Family and Community
Medicine (Dr Streiffer), Tulane University School of Medicine; and National
Heart, Lung, and Blood Institute, Bethesda, Md (Dr Roccella).
REFERENCES
| |
1. Wolz M, Cutler J, Roccella EJ, Rohde F, Thom T, Burt V. Statement from the National High Blood Pressure Education Program:
prevalence of hypertension. Am J Hypertens. 2000;13:103-104.
FULL TEXT
|
ISI
| PUBMED
2. American Heart Association. 2000 Heart and Stroke Statistical Update. Dallas, Tex: American Heart Association; 2000.
3. He J, Whelton PK. Elevated systolic blood pressure and risk of cardiovascular and renal
disease: overview of evidence from observational epidemiologic studies and
randomized controlled trials. Am Heart J. 1999;138(3, pt 2):S211-S219.
4. Klag MJ, Whelton PK, Randall BL, et al. Blood pressure and end-stage renal disease in men. N Engl J Med. 1996;334:13-18.
FREE FULL TEXT
5. MacMahon S, Peto R, Cutler J, et al. Blood pressure, stroke, and coronary heart disease, I: prolonged differences
in blood pressure: prospective observational studies corrected for the regression
dilution bias. Lancet. 1990;335:765-774.
FULL TEXT
|
ISI
| PUBMED
6. He J, Ogden LG, Bazzano LA, Vupputuri S, Loria C, Whelton PK. Risk factors for congestive heart failure in US men and women: NHANES
I Epidemiologic Follow-up Study. Arch Intern Med. 2001;161:996-1002.
FREE FULL TEXT
7. Whelton PK, He J. Blood pressure reduction. In: Hennekens CH, Buring JE, Manson JE, Ridker PM, eds. Clinical Trials in Cardiovascular Disease. Philadelphia, Pa: WB Saunders
Co; 1999:341-359.
8. Blood Pressure Lowering Treatment Trialists' Collaboration. Effects of ACE inhibitors, calcium antagonists, and other blood-pressure–lowering
drugs: results of prospectively designed overviews of randomised trials. Lancet. 2000;355:1955-1964.
FULL TEXT
|
ISI
| PUBMED
9. Burt VL, Cutler JA, Higgins M, et al. Trends in the prevalence, awareness, treatment, and control of hypertension
in the adult US population: data from the Health Examination Surveys, 1960
to 1991. Hypertension. 1995;26:60-69.
FREE FULL TEXT
10. Burt VL, Whelton PK, Roccella EJ, et al. Prevalence of hypertension in the US adult population: results from
the Third National Health and Nutrition Examination Survey, 1988-1991. Hypertension. 1995;25:305-313.
FREE FULL TEXT
11. The Joint National Committee on Prevention, Detection, Evaluation,
and Treatment of High Blood Pressure. The Sixth Report of the Joint National Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood Pressure. Arch Intern Med. 1997;157:2413-2446.
FREE FULL TEXT
12. Weir MR, Maibach EW, Bakris GL, et al. Implications of a health lifestyle and medication analysis for improving
hypertension control. Arch Intern Med. 2000;160:481-490.
FREE FULL TEXT
13. Shea S, Misra D, Ehrlich MH, Field L, Francis CK. Predisposing factors for severe, uncontrolled hypertension in an inner-city
minority population. N Engl J Med. 1992;327:776-781.
ABSTRACT
14. Alexander M, Tekawa I, Hunkeler E, et al. Evaluating hypertension control in a managed care setting. Arch Intern Med. 1999;159:2673-2677.
FREE FULL TEXT
15. Kotchen JM, Shakoor-Abdullah B, Walker WE, Chelius TH, Hoffmann RG, Kotchen TA. Hypertension control and access to medical care in the inner city. Am J Public Health. 1998;88:1696-1699.
FREE FULL TEXT
16. Hill MN, Bone LR, Kim MT, Miller DJ, Dennison CR, Levine DM. Barriers to hypertension care and control in young urban black men. Am J Hypertens. 1999;12:951-958.
FULL TEXT
|
ISI
| PUBMED
17. National Center for Health Statistics. Plan and operation of the Third National Health and Nutrition Examination
Survey 1988-94: series 1: programs and collection procedures. Vital Health Stat 1. 1994;(32):1-407.
18. Stata Corp. Stata Statistical Software: Release 5.0. College Station, Tex: Stata Corp; 1997.
19. Lang T. Factors that appear as obstacles to the control of high blood pressure. Ethn Dis. 2000;10:125-130.
PUBMED
20. Woolhandler S, Himmelstein D. Reverse targeting of preventive care due to lack of health insurance. JAMA. 1988;259:2872-2874.
FREE FULL TEXT
21. National Center for Health Statistics. Health, United States, 1995. Hyattsville, Md: Public Health Service; 1996:193-194.
22. Nieto FJ, Alonso J, Chambless LE, et al. Population awareness and control of hypertension and hypercholesterolemia:
the Atherosclerosis Risk in Communities study. Arch Intern Med. 1995;155:677-684.
FREE FULL TEXT
23. Bone LR, Hill MN, Stallings R, et al. Community health survey in an urban African-American neighborhood:
distribution and correlates of elevated blood pressure. Ethn Dis. 2000;10:87-95.
PUBMED
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Community-Based Participatory Research From the Margin to the Mainstream: Are Researchers Prepared?
Horowitz et al.
Circulation 2009;119:2633-2642.
ABSTRACT
| FULL TEXT
Consistency of Care and Blood Pressure Control among Elderly African Americans and Whites with Hypertension
Howard et al.
J Am Board Fam Med 2009;22:307-315.
ABSTRACT
| FULL TEXT
Counseling African Americans to Control Hypertension (CAATCH) Trial: A Multi-Level Intervention to Improve Blood Pressure Control in Hypertensive Blacks
Ogedegbe et al.
Circ Cardiovasc Qual Outcomes 2009;2:249-256.
ABSTRACT
| FULL TEXT
Prevalence of prehypertension and hypertension and associated risk factors among Turkish adults: Trabzon Hypertension Study
Erem et al.
J Public Health (Oxf) 2009;31:47-58.
ABSTRACT
| FULL TEXT
Prevalence, Awareness, Treatment, and Predictors of Control of Hypertension in New York City
Angell et al.
Circ Cardiovasc Qual Outcomes 2008;1:46-53.
ABSTRACT
| FULL TEXT
Trends in Statin Use and Low-Density Lipoprotein Cholesterol Levels Among US Adults: Impact of the 2001 National Cholesterol Education Program Guidelines
Mann et al.
The Annals of Pharmacotherapy 2008;42:1208-1215.
ABSTRACT
| FULL TEXT
Factors Associated With Hypertension Awareness, Treatment, and Control in Dallas County, Texas
Victor et al.
Arch Intern Med 2008;168:1285-1293.
ABSTRACT
| FULL TEXT
Prevention of Heart Failure: A Scientific Statement From the American Heart Association Councils on Epidemiology and Prevention, Clinical Cardiology, Cardiovascular Nursing, and High Blood Pressure Research; Quality of Care and Outcomes Research Interdisciplinary Working Group; and Functional Genomics and Translational Biology Interdisciplinary Working Group
Schocken et al.
Circulation 2008;117:2544-2565.
ABSTRACT
| FULL TEXT
Prevalence, Awareness, Treatment, and Control of Hypertension in the Jackson Heart Study
Wyatt et al.
Hypertension 2008;51:650-656.
ABSTRACT
| FULL TEXT
Impact of insurance and supply of health professionals on coverage of treatment for hypertension in Mexico: population based study
Bleich et al.
BMJ 2007;335:875-875.
ABSTRACT
| FULL TEXT
Association of Antihypertensive Therapy and Diastolic Hypotension in Chronic Kidney Disease
Peralta et al.
Hypertension 2007;50:474-480.
ABSTRACT
| FULL TEXT
Prevalence, Awareness, Treatment, and Control of Hypertension Among United States Adults 1999-2004
Ong et al.
Hypertension 2007;49:69-75.
ABSTRACT
| FULL TEXT
Adults' Lack of a Usual Source of Care: A Matter of Preference?
Viera et al.
Ann Fam Med 2006;4:359-365.
ABSTRACT
| FULL TEXT
Medical Risks in Living Kidney Donors: Absence of Proof Is Not Proof of Absence
Ommen et al.
CJASN 2006;1:885-895.
ABSTRACT
| FULL TEXT
Racial Disparities in Hypertension Prevalence, Awareness, and Management
Hertz et al.
Arch Intern Med 2005;165:2098-2104.
ABSTRACT
| FULL TEXT
Epidemiology of Uncontrolled Hypertension in the United States
Wang and Vasan
Circulation 2005;112:1651-1662.
FULL TEXT
Pharmacogenetic Association of the Angiotensin-Converting Enzyme Insertion/Deletion Polymorphism on Blood Pressure and Cardiovascular Risk in Relation to Antihypertensive Treatment: The Genetics of Hypertension-Associated Treatment (GenHAT) Study
Arnett et al.
Circulation 2005;111:3374-3383.
ABSTRACT
| FULL TEXT
Control of Hypertension in Adults With Chronic Kidney Disease in the United States
Peralta et al.
Hypertension 2005;45:1119-1124.
ABSTRACT
| FULL TEXT
The Prevalence of Prehypertension and Hypertension Among US Adults According to the New Joint National Committee Guidelines: New Challenges of the Old Problem
Wang and Wang
Arch Intern Med 2004;164:2126-2134.
ABSTRACT
| FULL TEXT
Excess Stroke in Mexican Americans Compared with Non-Hispanic Whites: The Brain Attack Surveillance in Corpus Christi Project
Morgenstern et al.
Am J Epidemiol 2004;160:376-383.
ABSTRACT
| FULL TEXT
Factors Associated With Hypertension Awareness, Treatment, and Control in a Representative Sample of the Chinese Population
Muntner et al.
Hypertension 2004;43:578-585.
ABSTRACT
| FULL TEXT
Treatment for newly diagnosed hypertension: patterns of prescribing and antihypertensive effectiveness in the UK
Walley et al.
JRSM 2003;96:525-531.
ABSTRACT
| FULL TEXT
Prediction of risk for first age-related cardiovascular events in an elderly population: the incremental value of echocardiography
Tsang et al.
J Am Coll Cardiol 2003;42:1199-1205.
ABSTRACT
| FULL TEXT
Prevalence, Awareness, Treatment, and Control of Hypertension in China
Gu et al.
Hypertension 2002;40:920-927.
ABSTRACT
| FULL TEXT
|
