How common is hypertension
What is the epidemiology of hypertension?
Hypertension remains a common disease among Americans. Data from the National Health and Nutrition Examination Survey reveal that 29% of Americans are hypertensive; this prevalence rate has remained stable for the past 15 years. African Americans bear the highest burden, as over 41% are hypertensive. Other racial groups (i.e. Whites, Asians, and Hispanics) demonstrate hypertension prevalence of 25% to 28%. During this time period, blood pressure (BP) control has improved, largely through the increased use of angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARB), and thiazide-type diuretics in single-pill or multiple-pill combinations. In 2001 to 2002, only 45% of treated hypertensive patients achieved control, defined as BPs <140/90 mm Hg (or <130/80 mm Hg for diabetic patients or chronic kidney disease [CKD] patients [patients with estimated glomerular filtration rates (GFR) <60 mL/min per 1.73 m 2 or urinary albumin concentrations >200 mg/g creatinine]). By 2009 to 2010, 60% of treated hypertensive patients had achieved control. However, BP control remains difficult for African Americans, Hispanics, patients with diabetes, and CKD patients. Compared to Caucasians, African Americans and Hispanics are 1.4- and 1.3-fold less likely to achieve control. Again, the greater use of thiazide-type diuretics improves BP control for African Americans. Nearly 70% of treated hypertensive patients without significant comorbidities achieved control by 2009 to 2010, though only approximately 45% of patients with either diabetes mellitus or CKD achieved control.
Obesity complicates hypertension treatment. A cross-sectional study of German hypertensive patients showed that obese patients (i.e., patients with body mass indices ≥30 kg/m 2 ) are 1.4- to 2-fold less likely to achieve BP control, compared to normal weight hypertensive patients. While
- • 12% of Americans are currently diabetic
- • by 2050, diabetic prevalence may increase to more than 25%
- • 36.5% of Americans are currently obese
- • by 2030, 41% may be obese, and 11% may be severely obese
- • 15% of Americans suffer from CKD
- • by 2030, the prevalence of CKD in adults over the age of 30 may be close to 50%
Recent epidemiologic studies confirm the association of albuminuria and poor BP control in patients with CKD. In a study of 232 US veterans with CKD, proteinuria, not estimated GFR, was found to be an independent predictor of systolic BP. Among the independent predictors of hypertension (age, race, and number of antihypertensive medications), proteinuria most strongly correlated with hypertension. Compared to estimated GFR, albuminuria (or proteinuria) is a stronger determinant of hypertension; albuminuria is also a stronger determinant of poor BP control.
