Article

Wang TJ, Vasan RS. Epidemiology of uncontrolled hypertension in the United States

Boston University, Boston, Massachusetts, United States
Circulation (Impact Factor: 14.95). 10/2005; 112(11):1651-62. DOI: 10.1161/CIRCULATIONAHA.104.490599
Source: PubMed
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    • "More recently, OSA has been identified as an independent risk factor for HT (Lavie et al., 2000; Peppard et al., 2000; Marin et al., 2012), as one of the major clinical conditions that favors poorly controlled HT (Oliveras and Schmieder, 2013), and as the most common condition associated with resistant HT (Pedrosa et al., 2011). OSA and HT are two prevailing risk factors for several cardiovascular events (Wang and Vasan, 2005; Baguet et al., 2009). Due to their high prevalence and cardiovascular morbidity (Wolf et al., 2007; Malhotra and Loscalzo, 2009), OSA and HT are now acknowledged as public health problems. "
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    ABSTRACT: Sleep apnea/hypopnea disorders include centrally originated diseases and obstructive sleep apnea (OSA). This last condition is renowned as a frequent secondary cause of hypertension (HT). The mechanisms involved in the pathogenesis of HT can be summarized in relation to two main pathways: sympathetic nervous system stimulation mediated mainly by activation of carotid body (CB) chemoreflexes and/or asphyxia, and, by no means the least important, the systemic effects of chronic intermittent hypoxia (CIH). The use of animal models has revealed that CIH is the critical stimulus underlying sympathetic activity and hypertension, and that this effect requires the presence of functional arterial chemoreceptors, which are hyperactive in CIH. These models of CIH mimic the HT observed in humans and allow the study of CIH independently without the mechanical obstruction component. The effect of continuous positive airway pressure (CPAP), the gold standard treatment for OSA patients, to reduce blood pressure seems to be modest and concomitant antihypertensive therapy is still required. We focus this review on the efficacy of pharmacological interventions to revert HT associated with CIH conditions in both animal models and humans. First, we explore the experimental animal models, developed to mimic HT related to CIH, which have been used to investigate the effect of antihypertensive drugs (AHDs). Second, we review what is known about drug efficacy to reverse HT induced by CIH in animals. Moreover, findings in humans with OSA are cited to demonstrate the lack of strong evidence for the establishment of a first-line antihypertensive regimen for these patients. Indeed, specific therapeutic guidelines for the pharmacological treatment of HT in these patients are still lacking. Finally, we discuss the future perspectives concerning the non-pharmacological and pharmacological management of this particular type of HT.
    Frontiers in Physiology 09/2014; 5:361. DOI:10.3389/fphys.2014.00361 · 3.50 Impact Factor
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    • "Several authors report that there might be no treatment intensification when the assessed values lie close to the desired threshold,8,10,11,21 especially if patients are already on therapy, and more time is needed to assess the effects of existing therapy.21 The presence of comorbidities raises uncertainty as to whether existing guidelines are systematically appropriate. "
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    ABSTRACT: Failure to initiate or intensify therapy according to evidence-based guidelines is increasingly being acknowledged as a phenomenon that contributes to inadequate management of chronic conditions, and is referred to as clinical inertia. However, the number and complexity of factors associated with the clinical reasoning that underlies the decision-making processes in medicine calls for a critical examination of the consistency of the concept. Indeed, in the absence of information on and justification of treatment decisions that were made, clinical inertia may be only apparent, and actually reflect good clinical practice. This integrative review seeks to address the factors generally associated with clinical inaction, in order to better delineate the concept of true clinical inertia.
    05/2014; 5:141-147. DOI:10.2147/AMEP.S59022
    • "In the United States, high blood pressure is responsible for one in six deaths with one in three adults suffering from hypertension [1], [2], [3], [4]. Over the last two decades, national-level statistics show improvements in the awareness, treatment and control of hypertension; however, they remain far from ideal [5]. "
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    ABSTRACT: Hypertension is an important and modifiable risk factor for cardiovascular disease and mortality. Over the last decade, national-levels of controlled hypertension have increased, but little information on hypertension prevalence and trends in hypertension treatment and control exists at the county-level. We estimate trends in prevalence, awareness, treatment, and control of hypertension in US counties using data from the National Health and Nutrition Examination Survey (NHANES) in five two-year waves from 1999-2008 including 26,349 adults aged 30 years and older and from the Behavioral Risk Factor Surveillance System (BRFSS) from 1997-2009 including 1,283,722 adults aged 30 years and older. Hypertension was defined as systolic blood pressure (BP) of at least 140 mm Hg, self-reported use of antihypertensive treatment, or both. Hypertension control was defined as systolic BP less than 140 mm Hg. The median prevalence of total hypertension in 2009 was estimated at 37.6% (range: 26.5 to 54.4%) in men and 40.1% (range: 28.5 to 57.9%) in women. Within-state differences in the county prevalence of uncontrolled hypertension were as high as 7.8 percentage points in 2009. Awareness, treatment, and control was highest in the southeastern US, and increased between 2001 and 2009 on average. The median county-level control in men was 57.7% (range: 43.4 to 65.9%) and in women was 57.1% (range: 43.0 to 65.46%) in 2009, with highest rates in white men and black women. While control of hypertension is on the rise, prevalence of total hypertension continues to increase in the US. Concurrent increases in treatment and control of hypertension are promising, but efforts to decrease the prevalence of hypertension are needed.
    PLoS ONE 04/2013; 8(4):e60308. DOI:10.1371/journal.pone.0060308 · 3.23 Impact Factor
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