title: Closing the gap in hypertension control between younger and older adults: National Health and Nutrition Examination Survey (NHANES) 1988 to 2010.
abstract: BACKGROUND
  Joint National Committee goal blood pressure for all adults was <140/<90 mm Hg or lower from 1984 to 2013. Adults aged ≥60 years (older) have mainly isolated systolic hypertension, with major trials attaining systolic blood pressure <150 but not <140 mm Hg. The main objective was to assess changes in hypertension control to <140/<90 mm Hg in younger (aged <60 years) and older adults and <150/<90 mm Hg in the latter.
  
  
  RESULTS
  National Health and Nutrition Examination Surveys (NHANES) 1988 to 1994, 1999 to 2004, and 2005 to 2010 were analyzed in adults aged ≥18 years. From 1988 to 1994 to 2005 to 2010, hypertension control to <140/<90 mm Hg improved in older (31.6% to 53.1%; P<0.001) and younger (45.7% to 55.9%; P<0.001) patients. The age gap in control declined from 14.1% (P<0.01) in 1988 to 1994 to 2.8% (P=0.13) in 2005 to 2010. Better hypertension control reflected increased percentages of older (55.6% to 77.5%) and younger (34.6% to 54.7%) patients on treatment and treated older (45.7% to 64.9%) and younger (56.8% to 73.4%) patients controlled (all P<0.001). Control to <150/<90 mm Hg rose from 48.8% to 69.9% in older adults. Antihypertensive medication number and percentages on ≥3 medications increased in both age groups but increased more in older patients (P<0.01). Blood pressure control was higher in both age groups with ≥2 healthcare visits per year and on statin therapy.
  
  
  CONCLUSIONS
  The age gap in hypertension control to <140/<90 mm Hg was virtually eliminated in 2005 to 2010 as clinicians intensified therapy, especially in older patients in whom isolated systolic hypertension predominates, controlling 70% to <150/<90 mm Hg. More frequent healthcare visits and the use of statin therapy may improve hypertension control in all adults.
authors.affiliation: From the University of South Carolina School of Medicine, Greenville, Greenville Health System, Care Coordination Institute, Greenville (B.M.E., J.M.F., A.S.); Department of Mathematics, College of Charleston, Charleston, SC (J.L.); and Medical University of South Carolina, Department of Pediatrics, Nephrology Division, Charleston (I.F.S.). began@carecoordinationinstitute.org.
authors.forename: Brent M
authors.initials: BM
authors.lastname: Egan
authors.affiliation: From the University of South Carolina School of Medicine, Greenville, Greenville Health System, Care Coordination Institute, Greenville (B.M.E., J.M.F., A.S.); Department of Mathematics, College of Charleston, Charleston, SC (J.L.); and Medical University of South Carolina, Department of Pediatrics, Nephrology Division, Charleston (I.F.S.).
authors.forename: Jiexiang
authors.initials: J
authors.lastname: Li
authors.affiliation: From the University of South Carolina School of Medicine, Greenville, Greenville Health System, Care Coordination Institute, Greenville (B.M.E., J.M.F., A.S.); Department of Mathematics, College of Charleston, Charleston, SC (J.L.); and Medical University of South Carolina, Department of Pediatrics, Nephrology Division, Charleston (I.F.S.).
authors.forename: Ibrahim F
authors.initials: IF
authors.lastname: Shatat
authors.affiliation: From the University of South Carolina School of Medicine, Greenville, Greenville Health System, Care Coordination Institute, Greenville (B.M.E., J.M.F., A.S.); Department of Mathematics, College of Charleston, Charleston, SC (J.L.); and Medical University of South Carolina, Department of Pediatrics, Nephrology Division, Charleston (I.F.S.).
authors.forename: J Michael
authors.initials: JM
authors.lastname: Fuller
authors.affiliation: From the University of South Carolina School of Medicine, Greenville, Greenville Health System, Care Coordination Institute, Greenville (B.M.E., J.M.F., A.S.); Department of Mathematics, College of Charleston, Charleston, SC (J.L.); and Medical University of South Carolina, Department of Pediatrics, Nephrology Division, Charleston (I.F.S.).
authors.forename: Angelo
authors.initials: A
authors.lastname: Sinopoli
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009749:Nutrition Surveys; D015995:Prevalence; D012307:Risk Factors; D017678:Sex Distribution; D055815:Young Adult
chemical_list: D000959:Antihypertensive Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: aged; blood pressure; epidemiology; hypertension; population; prevention
references.citation: Am J Med. 2013 Jun;126(6):501-8
references.pmid: 23541376
references.citation: JAMA. 2010 May 26;303(20):2043-50
references.pmid: 20501926
references.citation: J Gen Intern Med. 1997 Jan;12(1):7-14
references.pmid: 9034941
references.citation: Circulation. 2011 Aug 30;124(9):1046-58
references.pmid: 21824920
references.citation: J Hypertens. 2011 Oct;29(10):2004-13
references.pmid: 21881528
references.citation: J Am Soc Nephrol. 2007 Oct;18(10):2749-57
references.pmid: 17855641
references.citation: Am J Epidemiol. 2006 May 15;163(10):913-20
references.pmid: 16597707
references.citation: Arch Intern Med. 1997 Nov 24;157(21):2413-46
references.pmid: 9385294
references.citation: Am J Kidney Dis. 2002 Mar;39(3):445-59
references.pmid: 11877563
references.citation: Arch Intern Med. 2008 Feb 11;168(3):308-14
references.pmid: 18268173
references.citation: JAMA. 1998 Oct 7;280(13):1168-72
references.pmid: 9777817
references.citation: JAMA. 2006 May 3;295(17):2027-36
references.pmid: 16670411
references.citation: Circulation. 1999 Nov 23;100(21):2131-4
references.pmid: 10571970
references.citation: Arch Intern Med. 2003 Mar 24;163(6):681-7
references.pmid: 12639200
references.citation: Diabetes Care. 2013 Jan;36 Suppl 1:S11-66
references.pmid: 23264422
references.citation: Hypertension. 2001 Mar;37(3):869-74
references.pmid: 11244010
references.citation: Hypertens Res. 2008 Dec;31(12):2115-27
references.pmid: 19139601
references.citation: N Engl J Med. 1998 Dec 31;339(27):1957-63
references.pmid: 9869666
references.citation: N Engl J Med. 2010 Apr 29;362(17):1575-85
references.pmid: 20228401
references.citation: Circulation. 2013 Jul 2;128(1):29-41
references.pmid: 23817481
references.citation: JAMA. 2010 Jul 7;304(1):61-8
references.pmid: 20606150
references.citation: Circulation. 2005 Sep 13;112(11):1651-62
references.pmid: 16157784
references.citation: J Clin Hypertens (Greenwich). 2013 Mar;15(3):154-61
references.pmid: 23458586
references.citation: JAMA. 2014 Feb 5;311(5):507-20
references.pmid: 24352797
references.citation: Circulation. 2012 Jan 3;125(1):e2-e220
references.pmid: 22179539
references.citation: Am J Hypertens. 2008 Oct;21(10):1124-8
references.pmid: 18772861
references.citation: MMWR Morb Mortal Wkly Rep. 2012 Sep 7;61:703-9
references.pmid: 22951452
references.citation: J Clin Hypertens (Greenwich). 2013 May;15(5):310-20
references.pmid: 23614844
references.citation: Diabetes Care. 2004 Dec;27(12):2806-12
references.pmid: 15562189
references.citation: Arch Intern Med. 1984 May;144(5):1045-57
references.pmid: 6143542
references.citation: N Engl J Med. 2001 Aug 16;345(7):479-86
references.pmid: 11519501
references.citation: JAMA. 2002 Dec 11;288(22):2868-79
references.pmid: 12472329
references.citation: JAMA. 1991 Jun 26;265(24):3255-64
references.pmid: 2046107
references.citation: Hypertension. 2010 Aug;56(2):196-202
references.pmid: 20530299
references.citation: Hypertension. 2008 Jun;51(6):1403-19
references.pmid: 18391085
references.citation: N Engl J Med. 1993 Apr 1;328(13):914-21
references.pmid: 8446138
references.citation: Hypertension. 2004 Oct;44(4):398-404
references.pmid: 15326093
references.citation: Arch Intern Med. 2000 Aug 14-28;160(15):2281-6
references.pmid: 10927724
references.citation: Hypertension. 2003 Dec;42(6):1206-52
references.pmid: 14656957
references.citation: Lancet. 2002 Dec 14;360(9349):1903-13
references.pmid: 12493255
references.citation: J Am Coll Cardiol. 2014 Jul 1;63(25 Pt B):2889-934
references.pmid: 24239923
references.citation: N Engl J Med. 2008 May 1;358(18):1887-98
references.pmid: 18378519
references.citation: J Am Coll Cardiol. 2012 Aug 14;60(7):599-606
references.pmid: 22796254
references.citation: JAMA. 1979 Dec 7;242(23):2562-71
references.pmid: 490882
references.citation: Am J Kidney Dis. 2007 Dec;50(6):918-26
references.pmid: 18037092