Prevalence of Actions to Control High Blood Pressure --- 20 States, 2005

High blood pressure (HBP) increases the risk for heart disease and stroke, the first and third leading causes of death in the United States, respectively (1). The association between HBP and cardiovascular disease is independent of other risk factors (2). Nearly 30% of the U.S. adult population had HBP* during 2001--2004, according to the National Health and Nutrition Examination Survey (NHANES), and the prevalence has increased compared with 1988--1994 NHANES data (3,4). Although HBP is easily detectable and can be controlled with treatment, the condition is not controlled (i.e., systolic blood pressure <140 mm Hg and diastolic pressure <90 mm Hg) in approximately 70% of persons (3). A Healthy People 2010 objective (objective 12-11) is to increase the proportion of adults with HBP who are taking action to help control their blood pressure (5). To assess the prevalence of self-reported HBP and actions to control HBP, CDC analyzed 2005 data from an optional module in the Behavioral Risk Factor Surveillance System (BRFSS) in the 20 states that participated. The results indicated that although nearly all adults with HBP in the 20 states were taking some action to control their blood pressure, some persons can take additional actions to control their HBP, if indicated, including dietary changes, exercise, and taking prescribed medication.

BRFSS is a state-based, random-digit--dialed telephone survey of the U.S. civilian, noninstitutionalized population aged >18 years. The survey is administered in all 50 states, the District of Columbia (DC), and three U.S. territories (Guam, Puerto Rico, and the U.S. Virgin Islands). During 2005, a total of 24,447 of 101,574 respondents in 20 states responded "yes" to the following question: "Were you told on two or more different visits to a doctor or other health professional that you had high blood pressure?" Women who reported HBP only during pregnancy were not categorized as having HBP. Respondents also were asked the following five questions about actions they were currently taking to control their HBP: "Are you changing your eating habits to help lower or control your high blood pressure?" "Are you cutting down on salt to help lower or control your high blood pressure?" "Are you reducing alcohol use to help lower or control your high blood pressure?" "Are you exercising to help lower or control your high blood pressure?" "Are you currently taking medicine for your high blood pressure?" The median response rate for the 20 states was 51.0% (range: 34.6%--66.7%). Data were weighted to 2005 state population estimates. Prevalence estimates and 95% confidence intervals were calculated.

The age-adjusted prevalence of self-reported HBP was 19.4% (Table 1) for the 20 states combined. Self-reported HBP increased by age group, and the age-adjusted prevalence was highest among non-Hispanic blacks (27.2%). Among the 20 states, self-reported HBP tended to be highest in southern states, with Mississippi (25.5%), West Virginia (23.5%), Alabama (23.2%), Louisiana (22.1%), and Arkansas (21.9%) having the highest age-adjusted prevalence.

Approximately 98.1% of adults with self-reported HBP reported taking at least one action to lower or control their blood pressure, and a majority of respondents reported taking each of the five actions: 70.9% changed their eating habits, 79.5% decreased use of salt or did not use salt, 79.2% reduced consumption of alcohol or did not drink alcohol, 68.6% exercised, and 73.4% took antihypertensive medication (Table 2). Women were more likely than men to report changing eating habits and reducing consumption of alcohol or not drinking alcohol. Reducing use of salt or not using salt and taking antihypertensive medicine increased with age. A higher proportion of non-Hispanic blacks (90.0%) compared with other racial/ethnic groups reported reducing use of salt or not using salt.

The proportion of respondents with self-reported HBP who took each action varied by state. The percentage of adults who reported changing eating habits ranged from 59.7% (Montana) to 80.5% (Mississippi); the percentage who reduced use of salt or did not use salt ranged from 69.5% (Minnesota) to 83.8% (Hawaii); the percentage who reduced alcohol consumption or did not drink alcohol ranged from 61.4% (Minnesota) to 88.3% (Alabama); the percentage who exercised ranged from 57.6% (West Virginia) to 79.9% (Kansas); and the percentage who took antihypertensive medication ranged from 58.1% (Montana) to 85.8% (Louisiana).

Reported by: CH Denny, PhD, KJ Greenlund, PhD, C Ayala, PhD, NL Keenan, PhD, JB Croft, PhD, Div for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note:

Controlling HBP can reduce disability and death from heart disease, stroke, and other cardiovascular diseases. Recommendations to control HBP include both lifestyle changes and antihypertensive medication (2). The findings in this report indicate that, although nearly all adults with self-reported HBP take at least some health action to control their HBP, some persons can take additional actions if indicated. For example, although nearly 70% of respondents report exercising to control their HBP, 30% do not exercise to control HBP.

The findings in this report are subject to at least four limitations. First, data were based on self-reports and therefore were subject to recall bias and social desirability bias (i.e., providing a socially acceptable answer rather than the most accurate answer). Second, the degree and effects from the actions taken to reduce HBP were not assessed; for example, although exercising to control HBP was assessed, the frequency was not. Third, the combined results for these 20 states are not generalizable to the entire United States. Finally, the median response rate for the 20 states was only 51.0%; however, the reliability and validity of BRFSS measures have been demonstrated (6,7).

The CDC State Heart Disease and Stroke Prevention Program funds health departments in 32 states and DC to support heart-disease prevention activities through education, strategies to change physical and social environments to decrease risk for heart disease, and elimination of racial/ethnic disparities in heart-disease risk. In addition, CDC funds 15 WISEWOMAN (http://www.cdc.gov/wisewoman) projects in 14 states to provide low-income and underinsured or uninsured women aged 40--64 years with services to prevent cardiovascular disease; approximately 12,000 women have received services through WISEWOMAN in the past 4 years. WISEWOMAN projects operate on the local level in states and tribal organizations and provide preventive services, including blood-pressure screening and cholesterol testing, and lifestyle intervention programs to help women develop a healthier diet, increase physical activity, and quit using tobacco. These actions, combined with activities of clinicians and public health partners coordinated through A Public Health Action Plan to Prevent Heart Disease and Stroke (http://www.cdc.gov/dhdsp/library/action_plan/index.htm ), should increase identification, treatment, and control of HBP and clarify the actions needed to control HBP.

A comprehensive approach to lifestyle modification that targets diet, salt intake, alcohol intake, and exercise can help to control HBP (8). The Dietary Approaches to Stop Hypertension diet, which is low in saturated and total fat and emphasizes fruits, vegetables, and low-fat dairy products, has assisted with reducing blood pressure (9). HBP control requires maintaining lifestyle changes and taking prescribed medications. Self-management can increase overall HBP control (10), and improvements in counseling from health-care providers, patient education, and clinician-patient partnerships could further encourage adults with HBP to take action (2).

Acknowledgment

The findings in this report are based, in part, on data provided by BRFSS state coordinators.

References

1. Miniño AM, Heron MP, Smith BL. Deaths: preliminary data for 2004. Natl Vital Stat Rep 2006;54(19).
2. Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003;42:1206--52.
3. Hajjar I, Kotchen TA. Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988--2000. JAMA 2003;290:199--206.
4. National Center for Health Statistics. Health, United States, 2006. With chartbook on trends in the health of Americans. Hyattsville, MD: US Department of Health and Human Services, CDC, National Center for Health Statistics; 2006.
5. US Department of Health and Human Services. Healthy people 2010 (conference ed, in 2 vols). Washington, DC: US Department of Health and Human Services; 2000. Available at http://www.health.gov/healthypeople.
6. CDC. Behavioral Risk Factor Surveillance System. Summary data quality reports. Available at http://www.cdc.gov/brfss/technical_infodata/quality.htm.
7. Nelson D, Holtzman D, Bolen J, Stanwyck CA, Mack KA. Reliability and validity of measures from the Behavioral Risk Factor Surveillance System (BRFSS). Soz Praventivmed 2001;46(Suppl 1):S3--42.
8. Elmer PJ, Obarzanek E, Vollmer WM, et al. Effects of comprehensive lifestyle modification on diet, weight, physical fitness, and blood pressure control: 18-month results of a randomized trial. Ann Intern Med 2006;144:485--95.
9. Appel LJ, Moore TJ, Obarzanek E, et al. A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. New Engl J Med 1997;336:1117--24.
10. Chodosh J, Morton SC, Mojica W, et al. Meta-analysis: chronic disease self-management programs for older adults. Ann Intern Med 2005;143:427--38.

* HBP in NHANES was defined as systolic blood pressure of >140 mm Hg, diastolic blood pressure of >90 mm Hg, or taking antihypertensive medication.

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Table 2


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Date last reviewed: 5/2/2007