title: Hypertension in the United States, 1999 to 2012: progress toward Healthy People 2020 goals.
abstract: BACKGROUND
  To reduce the cardiovascular disease burden, Healthy People 2020 established US hypertension goals for adults to (1) decrease the prevalence to 26.9% and (2) raise treatment to 69.5% and control to 61.2%, which requires controlling 88.1% on treatment.
  
  
  RESULTS
  To assess the current status and progress toward these Healthy People 2020 goals, time trends in National Health and Nutrition Examination Surveys 1999 to 2012 data in 2-year blocks were assessed in adults ≥18 years of age age-adjusted to US 2010. From 1999 to 2000 to 2011 to 2012, prevalent hypertension was unchanged (30.1% versus 30.8%, P=0.32). Hypertension treatment (59.8% versus 74.7%, P<0.001) and proportion of treated adults controlled (53.3%-68.9%, P=0.0015) increased. Hypertension control to <140/<90 mm Hg rose every 2 years from 1999 to 2000 to 2009 to 2010 (32.2% versus 53.8%, P<0.001) before declining to 51.2% in 2011 to 2012. Modifiable factor(s) significant in multivariable logistic regression modeling include: (1) increasing body mass index with prevalent hypertension (odds ratio [OR], 1.44); (2) lack of health insurance (OR, 1.68) and <2 healthcare visits per year (OR, 4.24) with untreated hypertension; (3) healthcare insurance (OR, 1.69), ≥2 healthcare visits per year (OR, 3.23), and cholesterol treatment (OR, 1.90) with controlled hypertension.
  
  
  CONCLUSIONS
  The National Health and Nutrition Examination Survey 1999 to 2012 analysis suggests that Healthy People 2020 goals for hypertension ([1] prevalence shows no progress, [2] treatment was exceeded, and [3] control) have flattened below target. Findings are consistent with evidence that (1) obesity prevention and treatment could reduce prevalent hypertension, and (2) healthcare insurance, ≥2 healthcare visits per year, and guideline-based cholesterol treatment could improve hypertension control.
authors.affiliation: From the Care Coordination Institute and University of South Carolina School of Medicine-Greenville, Greenville Health System, Greenville, SC (B.M.E.); Department of Mathematics, College of Charleston, Charleston, SC (J.L.); Medical University of South Carolina and Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (F.N.H.); and Tulane University School of Medicine, New Orleans, LA (K.C.F.). began@ccihealth.org.
authors.forename: Brent M
authors.initials: BM
authors.lastname: Egan
authors.affiliation: From the Care Coordination Institute and University of South Carolina School of Medicine-Greenville, Greenville Health System, Greenville, SC (B.M.E.); Department of Mathematics, College of Charleston, Charleston, SC (J.L.); Medical University of South Carolina and Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (F.N.H.); and Tulane University School of Medicine, New Orleans, LA (K.C.F.).
authors.forename: Jiexiang
authors.initials: J
authors.lastname: Li
authors.affiliation: From the Care Coordination Institute and University of South Carolina School of Medicine-Greenville, Greenville Health System, Greenville, SC (B.M.E.); Department of Mathematics, College of Charleston, Charleston, SC (J.L.); Medical University of South Carolina and Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (F.N.H.); and Tulane University School of Medicine, New Orleans, LA (K.C.F.).
authors.forename: Florence N
authors.initials: FN
authors.lastname: Hutchison
authors.affiliation: From the Care Coordination Institute and University of South Carolina School of Medicine-Greenville, Greenville Health System, Greenville, SC (B.M.E.); Department of Mathematics, College of Charleston, Charleston, SC (J.L.); Medical University of South Carolina and Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (F.N.H.); and Tulane University School of Medicine, New Orleans, LA (K.C.F.).
authors.forename: Keith C
authors.initials: KC
authors.lastname: Ferdinand
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006293:Health Promotion / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology*; D007348:Insurance, Health / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009749:Nutrition Surveys / Q000706:statistics & numerical data*; D009765:Obesity / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
chemical_list: D000959:Antihypertensive Agents
keywords: Healthy People Programs; hypertension; nutrition surveys; population characteristics