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

Abstract

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.

Cross sectional study of automated blood pressure measurements throughout pregnancy

“…We found that a value close to 130/80 mmHg was above the 95th centile and that parity, age and body mass index at first visit had a significant influence on blood pressure in Caucasians. That blood pressure increases with age and body mass index is well known from population studies 4,14–17 . Blood pressure levels were slightly lower in Asians and Blacks than Caucasians despite a similar age across all ethnic groups, possibly because in our population Asians had a lower body mass index and Blacks a higher number of multiparae than Caucasians.…”

Intelligence in early adulthood and subclinical atherosclerosis in middle-aged men: the Vietnam Experience Study

“…As an occupational cohort, our sample is likely to be healthier than the general population of the same age and sex as individuals with severe illness or disability will not have been selected for army service. Comparison of mean levels of selected physiological risk factors in the men in our sample with those obtained from men of a similar, but not identical age range, in the second National Health Nutrition and Examination Survey (1976–80) suggest that the men in our sample have slightly lower systolic blood pressure36 and a lower prevalence of obesity,37 but differ little as regards total or HDL cholesterol 38. We have no means of knowing whether our sample differed in mean IQ scores from the national population of men of this age, but it is likely that men with the lowest scores will be under-represented because the test taken during selection for the army was designed to detect intellectual deficits 11.…”

Physical Activity and Health

“…This likely reflects differences in the circumstances of measurement since, as far as we know, no medication to slow the pulse rate spread rapidly between the early 1970s and the early 1980s. Medication may, however, explain the decline in average blood pressure over this period (Kumanyika et al 1998). As a further check, we also analyze self-reported hypertension.…”