Jeffery P. Hughes

Trends in Hypertension Prevalence, Awareness, Treatment, and Control in Older U.S. Adults: Data from the National Health and Nutrition Examination Survey 1988 to 2004

OBJECTIVES: To describe hypertension trends in U.S. adults aged 60 and older using National Health and Nutrition Examination Survey (NHANES) data.

Prevalence of peripheral arterial disease and risk factors in persons aged 60 and older: data from the National Health and Nutrition Examination Survey 1999-2004.

OBJECTIVES: Peripheral arterial disease (PAD) is associated with significant cardiovascular morbidity and mortality. The study objectives were to examine the prevalence of PAD and associated risk factors.

Abdominal Obesity, Body Mass Index, and Hypertension in US Adults: NHANES 2007–2010

BACKGROUND Both abdominal obesity, defined as waist circumference (WC) ≥ 102 cm for men and WC ≥ 88 cm for women and increased body mass index (BMI; kg/m²) are known to be associated with hypertension. The aim of this study was to examine the independent and the combined relationship between abdominal obesity and increased BMI and hypertension by age, race, and gender in a national sample. METHODS This report is based on national level cross-sectional data for adults aged 18 years and older (11,145 participants) from the US National Health and Nutrition Examination Survey (NHANES) 2007-2010. RESULTS Abdominal obesity, after adjusting for BMI categories and other covariables, was independently associated with hypertension. That is, survey participants classified as abdominally obese had almost 50% increased odds of being hypertensive (odds ratio (OR) 1.51, 95% confidence interval (CI) 1.27-1.81) after controlling for BMI. After adjusting for covariables, the groups of individuals classified as abdominally obese and normal BMI; as abdominally obese and overweight; and abdominally obese and obese each had a progressive increase in the odds of hypertension when compared with individuals who had a normal BMI and no abdominal obesity (OR 1.81, 95% CI 1.28-2.57, OR 1.87, 95% CI 1.55-2.25, and OR 3.23, 95% CI 2.63-3.96, respectively). CONCLUSIONS Abdominal obesity is independently associated with hypertension after adjusting for BMI. After adjusting for covariables and parameterizing BMI categories and abdominal obesity the new variable showed a progressive increase in the odds of hypertension. Both BMI and WC should be included in models assessing hypertension risks.

Multiple imputation of missing dual-energy X-ray absorptiometry data in the National Health and Nutrition Examination Survey†

In 1999, dual-energy x-ray absorptiometry (DXA) scans were added to the National Health and Nutrition Examination Survey (NHANES) to provide information on soft tissue composition and bone mineral content. However, in 1999-2004, DXA data were missing in whole or in part for about 21 per cent of the NHANES participants eligible for the DXA examination; and the missingness is associated with important characteristics such as body mass index and age. To handle this missing-data problem, multiple imputation of the missing DXA data was performed. Several features made the project interesting and challenging statistically, including the relationship between missingness on the DXA measures and the values of other variables; the highly multivariate nature of the variables being imputed; the need to transform the DXA variables during the imputation process; the desire to use a large number of non-DXA predictors, many of which had small amounts of missing data themselves, in the imputation models; the use of lower bounds in the imputation procedure; and relationships between the DXA variables and other variables, which helped both in creating and evaluating the imputations. This paper describes the imputation models, methods, and evaluations for this publicly available data resource and demonstrates properties of the imputations via examples of analyses of the data. The analyses suggest that imputation helps to correct biases that occur in estimates based on the data without imputation, and that it helps to increase the precision of estimates as well. Moreover, multiple imputation usually yields larger estimated standard errors than those obtained with single imputation.

Home Blood Pressure Monitoring and Hypertension Status Among US Adults: The National Health and Nutrition Examination Survey (NHANES), 2009–2010

BACKGROUND Currently, no national prevalence is available on home blood pressure monitoring (HBPM). METHODS This report is based on national-level, cross-sectional data for noninstitutionalized US adults aged ≥18 years (n = 6,001 participants) from the National Health and Nutrition Examination Survey (NHANES), 2009-2010. RESULTS Overall, 21.7% of the population reported HBPM in the past year. Using 2010 Census data as a reference, approximately 33 million (14.5%) individuals engaged in monthly or more frequent HBPM. The frequency of HBPM increased with higher age, higher body mass index, higher family income-to-poverty ratio, and a higher number of health-care visits (all, P < 0.05). Adults with health-care coverage engaged in monthly or more frequent HBPM than adults without coverage (16.1% vs. 8.4%; P < 0.05). Among people with hypertension (blood pressure ≥140/90mm Hg or currently taking medication), 36.6% engaged in monthly or more frequent HBPM. Of those with hypertension whom were aware, treated, and controlled, 41.9%, 43.5%, and 42.1%, respectively, engaged in monthly or more frequent HBPM. Adjusting for covariables, those who were aware of, treated for, and controlled their hypertension were more likely to have a higher frequency of HBPM than the reference: unaware, untreated, and uncontrolled (odds ratio (OR) = 3.59; OR = 3.96; and OR = 1.50, respectively). CONCLUSIONS Approximately 14.5% of adults engaged in monthly or more frequent HBPM. Being aware of hypertension, being pharmacologically treated, and being controlled were associated with an increased frequency of HBPM. Even among these categories of people with hypertension, <50% were using HBPM.

Total, free, and complexed prostate-specific antigen levels among US men, 2007–2010☆

BACKGROUND Screening for prostate cancer using prostate-specific antigen (PSA) is common. Prostate cancer has been associated with higher total PSA (tPSA), lower free PSA (fPSA), lower percent free PSA (%fPSA), and higher complexed PSA (cPSA). METHODS Total, free and complexed PSAs were performed on 3251 men ≥40years in the 2007-2010 National Health and Nutrition Examination Survey. Distributions of the PSA tests were examined by age, race and ethnicity, and body mass index (BMI) groups. Percentages of men at PSA thresholds were examined. RESULTS Total PSA geometric mean was 0.96μg/l among men aged ≥40years and increased from 0.74μg/l for men 40-49years, to 1.82μg/l for men 80years and older. Non-Hispanic Whites had lower age-adjusted mean tPSA (1.03μg/l) and cPSA (0.56μg/l) than non-Hispanic Blacks (tPSA 1.25μg/l and cPSA 0.72μg/l). Obese men had lower age-adjusted mean total, free and complexed PSAs (0.94, 0.27, and 0.51μg/l, respectively) than men with normal BMI (tPSA 1.21, fPSA 0.32, and cPSA 0.68μg/l, respectively). CONCLUSION Total, free and complexed PSAs increased with age; tPSA and cPSAs were highest in non-Hispanic Blacks; and total, free, and complexed PSAs were lowest in obese men.

Factors Associated With Hypertension Control in US Adults Using 2017 ACC/AHA Guidelines: National Health and Nutrition Examination Survey 1999–2016

BACKGROUND Factors and trends associated with hypertension control (BP < 130/80 mm Hg) and mean blood pressure (BP) among hypertensive adults (BP ≥1 30/80 mm Hg or medicated for hypertension). METHOD Data on 22,911 hypertensive US adults from the 1999-2016 National Health and Nutrition Examination Survey. RESULTS For men, hypertension control prevalence increased from 8.6% in 1999-2000 to 16.2% in 2003-2004 (P < 0.001), and continued the increasing trend afterwards to 23.2% in 2011-2012 (P < 0.001) and then plateaued. For women, hypertension control prevalence increased from 1999-2000 to 2009-2010 (10.8-26.3%, P < 0.001) and then plateaued. For men with hypertension, systolic BP decreased from 1999-2000 to 2011-2012 (135.7-132.8 mm Hg, P < 0.001) and then increased to 135.3 mm Hg in 2015-2016 (P < 0.001). For women with hypertension, systolic BP decreased from 1999-2000 to 2009-2010 (139.7-131.9 mm Hg; P < 0.001) and then increased to 134.4 mm Hg in 2015-2016 (P = 0.003). Diastolic BP decreased from 1999-2000 to 2015-2016 (men: 79.1-75.5 mm Hg and women: 76.4-73.7 mm Hg, P < 0.001 for both). In 2011-2016, hypertension control was 22.0% for men and 25.2% for women. The adjusted prevalence ratio (PR) of hypertension control were lower for non-Hispanic black men and women (PR = 0.72, 95% confidence interval (CI) = 0.61-0.86; PR = 0.83, 95% CI = 0.70-0.99, respectively; non-Hispanic white (NHW) as reference), Hispanic and non-Hispanic Asian men (PR = 0.70, 95% CI = 0.54-0.92; PR = 0.59, 95% CI = 0.39-0.86; respectively; NHW as reference). CONCLUSION Hypertension control significantly increased from 1999-2000 to 2011-2012 (men) and 2009-2010 (women) and then plateaued. About a quarter of US adults with hypertension were controlled in 2011-2016.