Progress in the battle against hypertension. Changes in blood pressure levels in the United States from 1960 to 1980.

Dannenberg, Andrew L.; Drizd, Terence; Horan, Michael J.; Haynes, Suzanne; Leaverton, Paul E.

doi:10.1161/01.hyp.10.2.226

Cited by 54 publications

(10 citation statements)

References 27 publications

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“…The observed decrease in mean systolic blood pressure and increase in the percentage of persons receiving antihypertensive drug therapy across time are consistent with prior reports from the National Center for Health Statistics (3,7,22). The model-based estimates before imputation also supported the finding of an overall secular decline in systolic blood pressure, although not consistently in all age-race-BMI subgroups.…”

Section: Discussionsupporting

confidence: 88%

Systolic Blood Pressure Trends in US Adults between 1960 and 1980 Influence of Antihypertensive Drug Therapy

Kumanyika

Landis

Matthews-Cook

et al. 1998

American Journal of Epidemiology

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Recent blood pressure trends reflect progress in hypertension control, but prevalent drug therapy precludes direct estimation of the component due to primary prevention. In data gathered on persons aged 35-74 years in three successive US health examination surveys (1960-1980), systolic blood pressure levels assuming no drug therapy were imputed by reassigning blood pressure to the upper end of the distribution for respondents reporting use of antihypertensive medication. Blood pressure was partitioned into four ordinal categories based on weighted percentiles of the 1960-1962 distributions for 35- to 44-year-old males and females who reported no use of antihypertensive medication. Cumulative logit models (alpha = 0.01) were used to estimate age- and sex-specific trends for blacks and whites within two strata (<25 or > or =25) of body mass index (BMI) (weight (kg)/height (m)2). Before imputation, systolic blood pressure decreased between 1960 and 1980; after imputation, significant decreases remained only in 35- to 44-year-olds. Strong associations of black race and BMI > or =25 with higher blood pressures were present in models with and without drug therapy. Thus, according to the models, there has been little progress in decreasing racial or BMI-related blood pressure differentials. Above the age of 44 years, blood pressure trends were largely attributable to medication use. In contrast, data for 35- to 44-year-olds suggest progress in primary prevention.

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Section: Discussionsupporting

confidence: 88%

Systolic Blood Pressure Trends in US Adults between 1960 and 1980 Influence of Antihypertensive Drug Therapy

Kumanyika

Landis

Matthews-Cook

et al. 1998

American Journal of Epidemiology

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“…This approach serves to decrease the blood pressure levels in the general population by relative modest amounts but in large populations has the potential to substantially reduce stroke morbidity and mortality, and to delay the onset of hypertension. 188 Stamler and colleagues estimated two decades ago that a 5 mmHg reduction of SBP in the adult population would result in a 14 percent overall reduction in mortality due to stroke. 189 As presented in Figures 1 and 2 and Table 1, the reduction in systolic blood pressure is consistent with the decline in stroke mortality, and corresponds to the predicted lower stroke mortality rates.…”

Section: Hypertension As a Factor In The Decline In Stroke Mortalitymentioning

confidence: 99%

Factors Influencing the Decline in Stroke Mortality

Lackland¹,

Roccella²,

Deutsch³

et al. 2014

Stroke

702

342

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Background and Purpose Stroke mortality has been declining since the early twentieth century. The reasons for this are not completely understood, although the decline is welcome. As a result of recent striking and more accelerated decreases in stroke mortality, stroke has fallen from the third to the fourth leading cause of death in the United States. This has prompted a detailed assessment of the factors associated with this decline. This review considers the evidence of various contributors to the decline in stroke risk and mortality and can be used in the design of future interventions regarding this major public health burden. Methods Writing group members were nominated by the committee chair and co-chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council’s Scientific Statement Oversight Committee and the AHA’s Manuscript Oversight Committee. The writers used systematic literature reviews, references to published clinical and epidemiology studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize evidence and indicate gaps in current knowledge. All members of the writing group had the opportunity to comment and approved the final version of this document. The document underwent extensive AHA internal peer review, Stroke Council Leadership review and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. Results The decline in stroke mortality over the past decades represents a major improvement in population health and is observed for both genders, and all race and age groups. In addition to the overall impact on fewer lives lost to stroke, the major decline in stroke mortality seen among individuals less than 65 years of age represents a reduction on years of potential life lost. The decline in mortality results from reduced stroke incidence and lower case fatality rates. These significant improvements in stroke outcomes are concurrent with cardiovascular risk factor control interventions. While it is difficult to calculate specific attributable risk estimates, the hypertension control efforts initiated in the 1970s appears to have had the most substantial influence on the accelerated stroke mortality decline. Although implemented later in the time period, diabetes and dyslipidemia control and smoking cessation programs, particularly in combination with hypertension treatment, also appear to have contributed to the stroke mortality decline. Telemedicine and stroke systems of care, while showing strong potential effects, have not been in place long enough to show their influence on the decline. Other factors had probable effects, but additional studies are needed to determine their contributions. Conclusion The decline in stroke mortality is real and represents a major public health and clinical medicine success story. The repositioning of str...

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“…[1][2][3] No studies have reported trends in incidence in hypertension presumably due to the difficulty in collecting such data. Incidence of hypertension cannot be estimated from ambulatory care surveys because the vast majority of medical care for hypertension relates to prevalent rather than to incident cases.…”

Section: Introductionmentioning

confidence: 99%

Incidence of hypertension in the Framingham Study.

Dannenberg¹,

Garrison²,

Kannel³

1988

Am J Public Health

Self Cite

140

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Incidence and trends in incidence of definite hypertension were analyzed based on 30 years follow-up of 5,209 subjects in the Framingham Heart Study cohort. Based on pooling of 15 two-year periods, hypertension incidence per biennium increased with age in men from 3.3 per cent at ages 30-39 to 6.2 per cent at ages 70-79, and in women from 1.5 per cent at ages 30-39 to 8.6 per cent at ages 70-79. No consistent trend in incidence rates was evident for IntroductionFew studies on incidence of hypertension in the general population have been published, although the prevalence of hypertension has been documented in a number of reports. 1-3 No studies have reported trends in incidence in hypertension presumably due to the difficulty in collecting such data. Incidence of hypertension cannot be estimated from ambulatory care surveys because the vast majority of medical care for hypertension relates to prevalent rather than to incident cases. The availability of incidence data allows health care planners to focus primary prevention efforts as well as secondary prevention efforts in the highest risk groups. This report presents data on cumulative incidence and trends in incidence of hypertension based on three decades of follow-up of the Framingham cohort.

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Progress in the battle against hypertension. Changes in blood pressure levels in the United States from 1960 to 1980.

Cited by 54 publications

References 27 publications

Systolic Blood Pressure Trends in US Adults between 1960 and 1980 Influence of Antihypertensive Drug Therapy

Systolic Blood Pressure Trends in US Adults between 1960 and 1980 Influence of Antihypertensive Drug Therapy

Factors Influencing the Decline in Stroke Mortality

Incidence of hypertension in the Framingham Study.

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