Trends in Prevalence and Control of Hypertension According to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) Guideline

Dorans, Kirsten; Mills, Katherine T.; Yang, Liu; He, Jiang

doi:10.1161/jaha.118.008888

Cited by 213 publications

(179 citation statements)

References 30 publications

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“…Potential explanations may include changes in prevalence, screening methods (blood pressure guidelines changed in 2003 and global) [1], a greater appreciation for the role hypertension plays in facilitating life-threatening comorbidities (physicians may be more likely to indicate hypertension as a underlying cause of death), changes in accuracy of ICD coding over time, antihypertensive medication use, blood pressure control [30], and increased sodium intake [31,32]. Importantly, recent NHANES data have pointed to an overall increase in the burden of hypertension, although control of hypertension has improved [1,30]. This is an interesting contradiction, in that non-Hispanic whites are associated with improved blood pressure control, but our findings indicate an acceleration in mortality for these individuals.…”

Section: Resultsmentioning

confidence: 99%

An acceleration in hypertension-related mortality for middle-aged and older Americans, 1999-2016: An observational study

2020

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Background Hypertension-related mortality has been increasing in recent years; however, limited information exists concerning rate, temporal, secular, and geographic trends in the United States. Methods and results Using CDC death certificate data spanning 1999-2016, we sought to delineate trends in deaths attributable to an underlying cause of hypertension using joinpoint regression and proportion testing. From 1999-2016, the hypertension-related mortality rate increased by 36.4% with an average annual percent change (AAPC) of 1.8% for individuals � 35 years of age. Interestingly, there was a notable acceleration in the AAPC of hypertension mortality between 2011 and 2016 (2.7% per year). This increase was due to a significant uptick in mortality for individuals � 55 years of age with the greatest AAPC occurring in individuals 55-64 (4.5%) and 65-74 (5.1%) years of age. Increased mortality and AAPC were pervasive throughout sex, ethnicity, and White and American Indian or Alaska Native race, but not Black or African American race. From 2011-2016, there were significant increases in AAPC for hypertension-related mortality with contributing causes of atrial fibrillation, heart failure, diabetes, obesity, and vascular dementia. Elevated mortality was observed for conditions with a contributing cause of hypertension that included chronic obstructive pulmonary disease, diabetes, Alzheimer's, Parkinson's, and all types of falls. Geographically, increases in AAPCs and mortality rates were observed for 25/51 States between 2011 and 2016. Conclusions Our results indicate hypertension-related mortality may have accelerated since 2011 for middle-aged and older Americans, which may create new challenges in care and healthcare planning.

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Section: Resultsmentioning

confidence: 99%

An acceleration in hypertension-related mortality for middle-aged and older Americans, 1999-2016: An observational study

2020

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“…Cholesterol, triglyceride, and low-density lipoprotein (LDL) levels did not worsen between 1999 and 2014, thanks to effective management and public awareness (14). Systolic blood pressure levels were also relatively stable from 1999 to 2016 (15). Thus, the stagnation may be less related to treatment failures and more due to unfavorable trends in the prevalence of underlying risk factors that require treatment.…”

Section: Discussionmentioning

confidence: 99%

US life expectancy stalls due to cardiovascular disease, not drug deaths

Mehta

Abrams

Myrskylä

2020

Proc. Natl. Acad. Sci. U.S.A.

145

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After decades of robust growth, the rise in US life expectancy stalled after 2010. Explanations for the stall have focused on rising drug-related deaths. Here we show that a stagnating decline in cardiovascular disease (CVD) mortality was the main culprit, outpacing and overshadowing the effects of all other causes of death. The CVD stagnation held back the increase of US life expectancy at age 25 y by 1.14 y in women and men, between 2010 and 2017. Rising drug-related deaths had a much smaller effect: 0.1 y in women and 0.4 y in men. Comparisons with other high-income countries reveal that the US CVD stagnation is unusually strong, contributing to a stark mortality divergence between the US and peer nations. Without the aid of CVD mortality declines, future US life expectancy gains must come from other causes-a monumental task given the enormity of earlier declines in CVD death rates. Reversal of the drug overdose epidemic will be beneficial, but insufficient for achieving pre-2010 pace of life expectancy growth.life expectancy | mortality | cardiovascular disease | drug-related mortality | opioid epidemic L ife expectancy in the United States increased at a phenomenal pace throughout the twentieth century, by nearly 2 y per decade (1). A major driver of the improvement after 1970 was the decline in cardiovascular disease (CVD) mortality. This "CVD revolution" has been attributed to improved pharmacological management, advances in surgical techniques, and healthier lifestyles (2). US death rates from CVD halved between 1970 and 2002 (3).After 2010, however, US life expectancy growth stalled and has most recently been declining. A critical question for American health policy is how to return US life expectancy to its pre-2010 growth rate. While much attention is being directed at drug-related deaths (4-6), we demonstrate that the changing trajectory of CVD deaths has been the most consequential cause-specific trend for the post-2010 US life expectancy stall. This link has not been empirically demonstrated, in part, because past analyses have focused on the very recent period in which CVD mortality had already stalled. For example, Ho and Hendi (5) was concerned with the year-over-year life expectancy decline that occurred during 2014-2015, and concluded that the US decline was mainly attributable to drug-related mortality; and Barbieri (4) focused on drug-related mortality in an analysis of causes of deaths that have contributed to the US shortfall in life expectancy relative to 12 other high-income countries in 2014. Consistent with our findings, Barbieri (4) found that drug-related mortality accounted for only about 10% of the US shortfall in 2014, and concluded, "Overall, the largest [reduction in the US life expectancy shortfall] would be achieved by reducing the US disadvantage in mortality not from drug use, alcohol and chronic liver diseases or suicide, but from other broad cause-of-death categories." In this paper, we show that CVD is the key cause-of-death category for understanding the US life expectanc...

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“…Third, we examined the role of the primary hypertension, which was present in one third of our participants—the rate common for the age group (Dorans, Mills, Liu, & He, ). The subjects with and without this diagnosis did not differ in IAc, MSCEIT scores, right aIns activation, and the mean ADC value.…”

Section: Resultsmentioning

confidence: 99%

The ability to understand emotions is associated with interoception‐related insular activation and white matter integrity during aging

et al. 2020

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Cerebral small vessel disease (SVD) is a major cause of cognitive impairment in elderly people. While most research focuses on the role of the classical vascular risk factors in SVD, a description of the psychophysiological mechanisms leading to the age-related brain damage may open new possibilities for prophylaxis. In the current study, we evaluated the associations between emotional abilities, interoception, and age-related vascular white matter degeneration. The work was influenced, first, by multiple studies recognizing alexithymia as a cardiovascular risk factor; second, by theories of emotions linking body's allostasis and emotional regulation; and third, by neuroimaging data highlighting the shared role of the insular cortex in interoceptive and emotional processing. In a sample of older female adults (N = 30), we performed the Mayer-Salovey-Caruso Emotional Intelligence Test, functional MRI using the heartbeat detection task, and evaluation of white matter microstructural integrity using diffusion weighted imaging. The ability to understand and analyze emotions-one of the four components of emotional intelligence-was found to be associated with higher interoception-related activation of the right anterior insula and preserved white matter microstructure. We interpret these results in light of the concept of Embodied Predictive Interoception Coding, which proposes that emotional processing, interoception, and allostasis (antecedent top-down regulation of the body's internal milieu) may rely on the shared neural mechanisms of predictive coding. The study demonstrates feasibility of the investigation of cerebrovascular diseases form a psychophysiological perspective and calls for future research.

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Trends in Prevalence and Control of Hypertension According to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) Guideline

Cited by 213 publications

References 30 publications

An acceleration in hypertension-related mortality for middle-aged and older Americans, 1999-2016: An observational study

An acceleration in hypertension-related mortality for middle-aged and older Americans, 1999-2016: An observational study

US life expectancy stalls due to cardiovascular disease, not drug deaths

The ability to understand emotions is associated with interoception‐related insular activation and white matter integrity during aging

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