US trends in prevalence, awareness, treatment, and control of hypertension, 1988-2008

Trends in blood pressure and hypertension among Chinese children and adolescents: China Health and Nutrition Surveys 1991-2004

OBJECTIVE

To observe the trends in blood pressure (BP) and prevalence of hypertension among Chinese children and adolescents.

METHODS

Data were extracted from the China Health and Nutrition Survey conducted from 1991 to 2004; 8247 children and adolescents aged 6-17 years were selected for this study. Multivariate linear regression analysis and multivariate logistic regression analysis were performed to evaluate the secular trends in BP levels and prevalence of hypertension, respectively.

RESULTS

During the study period, there was an upward trend in BP in Chinese children and adolescents. After adjustment for gender, age and weight status, the prevalence of pre-hypertension and hypertension increased dramatically from 1991 to 2004, with average relative increases of 6.38% and 8.13% in children and adolescents, respectively. Overweight was strongly associated with pre-hypertension and hypertension in comparison with normal weight, with odds ratios (95% confidence intervals) of 2.21 (1.58-3.11) and 4.13 (3.32-5.13), respectively.

CONCLUSION

BP levels and prevalence of hypertension increased dramatically among Chinese children and adolescents from 1991 to 2004.

Trends in low-risk lifestyle factors among adults in the United States: findings from the Behavioral Risk Factor Surveillance System 1996-2007

OBJECTIVE

Our objective was to examine recent trends in low-risk lifestyle factors for chronic diseases (not currently smoking, any exercise during the past 30 days, consuming fruits and vegetables ≥5 times per day, and body mass index <25kg/m(2)) among U.S. adults.

METHODS

We used data from 1,580,220 adults aged ≥18 years who participated in one of seven Behavioral Risk Factor Surveillance System surveys conducted from 1996 to 2007.

RESULTS

The age-adjusted percentage of adults meeting all four low-risk lifestyle factors was 8.5% in 1996 and 7.7% in 2007 (p for linear trend <0.001). Significant decreasing trends were noted for men, women, whites, Hispanics, and most age groups. The percentages of participants who were not currently smoking, who had done any exercise during the past 30 days, who reported consuming fruits and vegetables ≥5 times per day, and who had a body mass index <25kg/m(2) were 70.9%, 76.2%, 47.9% and 24.3%, respectively, in 1996 and 77.1%, 80.0%, 37.8%, and 24.5%, respectively, in 2007. Women and whites were more likely than their counterparts to meet all four criteria.

CONCLUSIONS

From 1996 to 2007, the percentage of U.S. adults meeting all four low-risk lifestyle factors decreased slightly.

A web-based patient activation intervention to improve hypertension care: study design and baseline characteristics in the web hypertension study

BACKGROUND

Despite the known health risks of hypertension, many hypertensive patients still have uncontrolled blood pressure. Clinical inertia, the tendency of physicians not to intensify treatment, is a common barrier in controlling chronic diseases. This trial is aimed at determining the impact of activating patients to ask providers to make changes to their care through tailored feedback.

METHODS

Diagnosed hypertensive patients were enrolled in this RCT and randomized to one of two study groups: (1) the intervention condition--Web-based hypertension feedback, based on the individual patient's self-report of health variables and previous BP measurements, to prompt them to ask questions during their next physician's visit about hypertension care (2) the control condition--Web-based preventive health feedback, based on the individual's self-report of receiving preventive care (e.g., pap testing), to prompt them to ask questions during their next physician's visit about preventive care. The primary outcome of the study is change in blood pressure and change in the percentage of patients in each group with controlled blood pressure.

CONCLUSION

Five hundred participants were enrolled and baseline characteristics include a mean age of 60.0 years; 57.6% female; and 77.6% white. Overall 37.7% participants had uncontrolled blood pressure; the mean body mass index (BMI) was in the obese range (32.4) and 21.8% had diabetes. By activating patients to become involved in their own care, we believe the addition of the web-based intervention will improve blood pressure control compared to a control group who receive web-based preventive messages unrelated to hypertension.

Patients' perspectives of a multifaceted intervention with a focus on technology: a qualitative analysis

BACKGROUND

Few studies have investigated the effectiveness of multifaceted interventions from the study participants' perspective. We conducted qualitative interviews to understand patients' experiences with a multifaceted blood pressure (BP) control intervention involving interactive voice response technology, home BP monitoring, and pharmacist-led BP management. In the randomized study, the intervention resulted in clinically significant decreases in BP.

METHODS AND RESULTS

We used insights generated from in-depth interviews from all study participants randomly assigned to the multifaceted intervention or usual care (n=146) to create a model explaining the observed improvements in health behavior and clinical outcomes. The data were analyzed using qualitative content analysis methods and consultative and reflexive team analysis. Six explanatory factors emerged from the patients' interviews: (1) improved relationships with medical personnel; (2) increased knowledge of hypertension; (3) increased participation in their health care and personal empowerment; (4) greater understanding of the impact of health behavior on BP; (5) high satisfaction with technology used in the intervention; and, for some patients, (6) increased health care utilization. Eighty-six percent of the intervention patients and 62% of the usual care patients stated that study participation had a positive effect on them. Of those expressing a positive effect, 68% (intervention) and 55% (usual care) reached their systolic BP goal.

CONCLUSIONS

Establishing bidirectional conversations between patients and providers is a key element of successful hypertension management. Home BP monitoring coupled with interactive voice response technology reporting facilitates such conversations.

The impact of Medicare Part D on medication treatment of hypertension

OBJECTIVE

To evaluate Medicare Part D's impact on use of antihypertensive medications among seniors with hypertension.

DATA SOURCES

Medicare-Advantage plan pharmacy data from January 1, 2004 to December 12, 2007 from three groups who before enrolling in Part D had no or limited drug benefits, and a comparison group with stable employer-based coverage.

STUDY DESIGN

Pre-post intervention with a comparison group design was used to study likelihood of use, daily counts, and substitutions between angiotensin-converting enzyme inhibitors and angiotensin-II receptor blockers (ARBs).

PRINCIPAL FINDINGS

Antihypertensive use increased most among those without prior drug coverage: likelihood of use increased (odds ratio = 1.40, 95 percent confidence interval [CI] 1.25-1.56), and daily counts increased 0.29 (95 percent CI 0.24-0.33). Proportion using ARBs increased from 40 to 46 percent.

CONCLUSIONS

Part D was associated with increased antihypertensive use and use of ARBs over less expensive alternatives.

Intergenerational transmission of chronic illness self-care: results from the caring for hypertension in African American families study

PURPOSE OF THE STUDY

African Americans often experience early onset of hypertension that can result in generations of adults managing high blood pressure concurrently. Using a model based on the Theory of Interdependence, this study examined whether intergenerational transmission of hypertension knowledge and self-efficacy would affect hypertension self-care of older parents and their adult children.

DESIGN AND METHODS

We recruited 95 African American older parent-adult child dyads with hypertension. We constructed separate logistic regression models for older parents and adult children with medication adherence as the outcome. Each model included individual demographic and health characteristics, the partner's knowledge, and self-efficacy to manage hypertension and dyad-related characteristics.

RESULTS

Parents were more adherent with medication than adult children (67.4% vs. 49.5%, p < .012). There were no significant factors associated with parent medication adherence. In adjusted models for adult children, medication adherence was associated with child's gender (odds ratio [OR] = 3.29, 95% confidence interval [CI] = 1.26-8.59), parent beliefs that the child had better hypertension self-care (OR = 4.36, 95% CI = 1.34-14.17), and child reports that the dyad conversed about hypertension (OR = 3.48, 95% CI = 1.18-10.29). Parental knowledge of hypertension and parent's self-efficacy were weakly associated with adult children's medication adherence (OR = 1.35, 95% CI = 0.99-1.84 and OR = 2.59, 95% CI = 0.94-7.12, respectively).

IMPLICATIONS

Interventions should consider targeting African American older adults to increase self-care knowledge and empower them as a primary influencer of hypertension self-care within the family.