Tatiana Nwankwo

Trends in Blood Pressure Among Adults With Hypertension: United States, 2003 to 2012

The aim of this study is to describe trends in the awareness, treatment, and control of hypertension; mean blood pressure; and the classification of blood pressure among US adults 2003 to 2012. Using data from the National Health and Nutrition Examination Survey 2003 to 2012, a total of 9255 adult participants aged ≥18 years were identified as having hypertension, defined as measured blood pressure ≥140/90 mm Hg or taking prescription medication for hypertension. Awareness and treatment among hypertensive adults were ascertained via an interviewer administered questionnaire. Controlled hypertension among hypertensive adults was defined as systolic blood pressure <140 mm Hg and diastolic blood pressure <90 mm Hg. Blood pressure was categorized as optimal blood pressure, prehypertension, and stage I and stage II hypertension. Between 2003 and 2012, the percentage of adults with controlled hypertension increased (P-trend <0.01). Hypertensive adults with optimal blood pressure and with prehypertension increased from 13% to 19% and 27% to 33%, respectively (P-trend <0.01 for both groups). Among hypertensive adults who were taking antihypertensive medication, uncontrolled hypertension decreased from 38% to 30% (P-trend <0.01). Similarly, a decrease in mean systolic blood pressure was observed (P-trend <0.01); however, mean diastolic blood pressure remained unchanged. The trend in the control of blood pressure has improved among hypertensive adults resulting in a higher percentage with blood pressure at the optimal or prehypertension level and a lower percentage in stage I and stage II hypertension. Overall, mean systolic blood pressure decreased as did the prevalence of uncontrolled hypertension among the treated hypertensive population.

Assessing the Validity of the Omron HEM‐907XL Oscillometric Blood Pressure Measurement Device in a National Survey Environment

J Clin Hypertens (Greenwich). 2010;12:22–28. ©2009 Wiley Periodicals, Inc.

Mean mid-arm circumference and blood pressure cuff sizes for U.S. adults: National Health and Nutrition Examination Survey, 1999-2010.

BackgroundAccurately measuring blood pressure (BP) requires choosing an appropriate BP cuff size. ObjectivesThis study examined trends in mid-arm circumference (mid-AC) and distribution of BP cuff sizes using 1999–2002, 2003–2006, and 2007–2010 National Health and Nutrition Examination Survey (NHANES) data. MethodsNHANES uses a complex multistage probability sample design to select participants who are representative of the entire civilian, noninstitutionalized US population. The analytic sample consisted of 28 233 participants aged 20 years or older. Mid-AC and BP cuff sizes were analyzed across survey years by sex, age, race/ethnicity, hypertension, and diabetic status. ResultsData from NHANES 2007–2010 show that the mean mid-AC for men was 34.2 cm and for women was 31.9 cm. Men showed a significant trend in mid-AC (from 33.9 cm in 1999–2002 to 34.2 cm in 2007–2010; P<0.05 for trend). In addition, 42.9% of men and 25.3% of women needed a large adult BP cuff and 1.9% of men and 2.8% of women needed thigh cuffs to be appropriately cuffed. Moreover, 52% of hypertensive men, 38% of hypertensive women, 59.1% of diabetic men, and 53.6% of diabetic women required the use of BP cuffs with sizes different from those of standard adult-sized BP cuffs for accurate BP measurement. ConclusionThere was an overall significant trend in the mean mid-AC in cm for men but not for women. On the basis of NHANES 2007–2010 data, ∼45% of adult men and ∼28% of adult women required the use of BP cuffs with sizes different from those of standard adult-sized BP cuffs for accurate BP measurement.

Collection and laboratory methods for dried blood spots for hemoglobin A1c and total and high-density lipoprotein cholesterol in population-based surveys

BACKGROUND The Health Measures at Home Study was a study designed to evaluate the feasibility of incorporating dried blood spots (DBS) collection into the National Health Interview Survey and to compare the proficiencies between field interviewers and health technicians in obtaining DBS. METHODS DBS collection and venipuncture were attempted on 125 participants. The DBS were collected in the participants home and venous blood was collected in the National Health and Nutrition Examination Survey (NHANES) mobile examination center. The DBS results were compared to venous results in the NHANES for the measurements of hemoglobin A1c (HbA1c) and total and high-density lipoprotein (HDL) cholesterol. RESULTS Field interviewers and health technicians were able to collect the DBS for greater than 95% of participants. For DBS, health technicians and field interviewers were highly correlated for HbA1c (r=0.92) and total cholesterol (r=0.89), but not for HDL cholesterol (r=0.72). The DBS results of interviewers and health technicians compared to the venous method for HbA1c (r=0.90), but did not compare well for HDL cholesterol (r=0.64-0.66) and total cholesterol (r=0.65-0.67). CONCLUSION DBS was comparable to venous HbA1c, but not for total and HDL cholesterol. Health technicians and field interviewers had similar performance for DBS methods, except HDL cholesterol.

Mid-arm circumference and recommended blood pressure cuffs for children and adolescents aged between 3 and 19 years: data from the National Health and Nutrition Examination Survey, 1999-2010.

BackgroundAccurately measuring blood pressure (BP) requires choosing an appropriate BP cuff size. ObjectivesThis study examined trends in mid-arm circumference (mid-AC) and in the distribution of appropriate BP cuffs using 1999–2010 National Health and Nutrition Examination Survey (NHANES) data. MethodsNHANES uses a complex multistage probability sample design to select participants who are representative of the entire civilian, noninstitutionalized US population. The analytic sample consisted of 21 350 participants aged between 3 and 19 years at the time of examination. The mean mid-AC and the percentage of children requiring recommended BP cuff sizes were analyzed across survey years and by sex, age, race/ethnicity, and age-specific and sex-specific BMI categories. ResultsDuring NHANES 1999–2010, the overall trend in mean mid-AC in cm for boys and girls was not significant. During NHANES 2007–2010, 24% of boys aged between 9 and 11 years, 53% of boys aged between 12 and 15 years, and 89% of boys aged between 16 and 19 years required a standard adult cuff or larger to be cuffed correctly. Corresponding estimates for girls were 22, 48, and 57%, respectively. During NHANES 2007–2010, 30.4% of obese boys and 24.3% of obese girls required a large adult cuff and 2.1% of obese boys and 0.9% of obese girls required a thigh cuff for appropriate cuffing. ConclusionDuring NHANES 2007–2010, 20% of boys and girls as young as 9–11 years required a standard adult cuff to be cuffed appropriately. In addition, approximately one-third of obese participants required adult large BP cuffs to be cuffed appropriately.

Trends in Blood Pressure Among Adults With Hypertension

The aim of this study is to describe trends in the awareness, treatment, and control of hypertension; mean blood pressure; and the classification of blood pressure among US adults 2003 to 2012. Using data from the National Health and Nutrition Examination Survey 2003 to 2012, a total of 9255 adult participants aged ≥18 years were identified as having hypertension, defined as measured blood pressure ≥140/90 mm Hg or taking prescription medication for hypertension. Awareness and treatment among hypertensive adults were ascertained via an interviewer administered questionnaire. Controlled hypertension among hypertensive adults was defined as systolic blood pressure <140 mm Hg and diastolic blood pressure <90 mm Hg. Blood pressure was categorized as optimal blood pressure, prehypertension, and stage I and stage II hypertension. Between 2003 and 2012, the percentage of adults with controlled hypertension increased (P-trend <0.01). Hypertensive adults with optimal blood pressure and with prehypertension increased from 13% to 19% and 27% to 33%, respectively (P-trend <0.01 for both groups). Among hypertensive adults who were taking antihypertensive medication, uncontrolled hypertension decreased from 38% to 30% (P-trend <0.01). Similarly, a decrease in mean systolic blood pressure was observed (P-trend <0.01); however, mean diastolic blood pressure remained unchanged. The trend in the control of blood pressure has improved among hypertensive adults resulting in a higher percentage with blood pressure at the optimal or prehypertension level and a lower percentage in stage I and stage II hypertension. Overall, mean systolic blood pressure decreased as did the prevalence of uncontrolled hypertension among the treated hypertensive population.

Blood pressure cuff comparability study.

BackgroundManufacturer-supplied blood pressure (BP) cuffs are part of the automatic oscillometric BP devices algorithm. Materials and methodsThis study assessed the differences in BP values using the Omron HEM 907-XL (Omron) device with two types of cuffs: the Baum cuff (BC) and the supplied Omron cuff (OC). A sample of 102 adults participated in the study, 34 per cuff size (adult, large, and extra-large). After a 5-min resting period, three pairs of BP determinations (systolic and diastolic) were taken simultaneously on both arms. One arm was cuffed with a BC and the other arm was cuffed with an OC. The cuffs were switched to opposite arms after 5 min of rest. The order was decided randomly as to which cuff was applied to which arm first. ResultsThe BP readings were highly correlated between the cuffs (systolic BP, r=0.98; diastolic BP, r=0.98). The overall mean differences (BC−OC) were 2.66 mmHg (SD=3.9 mmHg) for systolic BP (P<0.05) and 0.33 mmHg (SD=2.03 mmHg) for diastolic BP (P>0.05). Increased cuff size corresponded to increased differences in systolic BP values (adult: 1.51 mmHg; large: 2.56 mmHg; and extra-large: 3.9 mmHg; P<0.05). For diastolic BP values, a statistically significant difference was observed only for adult cuff size (difference=1.31 mmHg, SD=1.34 mmHg, P<0.05). ConclusionUsing a BC with the Omron could result in higher systolic BP readings and higher diastolic BP readings with the adult cuff size.

Comparison of blood pressure measurements obtained in the home setting: analysis of the Health Measures at Home Study.

BackgroundAutomated blood pressure (BP) devices have been used in the home for self-management purposes and are increasingly being used in population-based research. Although these devices are convenient and affordable and may be used by inexperienced lay personnel, the potential impact of an examiner’s skill level on the results needs to be evaluated quantitatively. The aim of this study was to compare BP measurements obtained in a home setting by personnel with healthcare experience with those obtained by personnel without healthcare experience. In addition, the percent agreement in high blood pressure (HBP) classification between the home BP measurement by the field interviewer (FI) and measurements obtained in a standardized environment was examined. MethodsThe Health Measures at Home Study was a pilot study carried out among 128 adult participants recruited from the National Health and Nutrition Examination Survey. The Health Measures at Home Study provided the opportunity to compare the BP values obtained with an automated device in a home setting by both experienced health technicians (HTs) with those obtained by FIs who had no healthcare experience. Differences between measurements obtained by the HT and measurements obtained by the FI were assessed using paired t-tests, Pearson’s correlations, and Bland–Altman plots. Percent agreement and &kgr;-statistics were used to assess agreement in HBP classification between examiners in the home. Measurements obtained by the FI were also compared with those obtained in the National Health and Nutrition Examination Survey mobile exam center (MEC) by a physician using percent agreement and &kgr;-statistics. ResultsThere was a high correlation in both systolic blood pressure (SBP; r=0.903) and diastolic blood pressure (DBP; r=0.894) between measurements obtained by HTs and those obtained by FIs. The mean SBP and DBP obtained by the FIs (SBP, 119.0±14.4 mmHg; DBP, 71.9±9.8 mmHg) were significantly higher than the HT measurements (SBP, 117.0±12.7 mmHg; DBP, 69.9.9±9.2 mmHg). In the home, the FI classified 11.7% as having HBP, whereas the HT classified 7.0%. The percent of individuals classified as having HBP by the physician in the MEC was 10.2% of the participants. ConclusionOperationally, FIs could take BP measurements in the home; however, there were some differences between measurements obtained by the FI and HT. The absolute difference between measurements obtained by the FI and those obtained by the HT in the home showed that measurements obtained by the FI tended to be higher than the HT, but the magnitude of these differences was less than 5 mmHg. The HT classified 7.0% of HBP whereas the FI classified 11.7% of HBP. Similarly, the FI and the MEC physician classified a different percent of individuals with HBP. Further investigation is warranted to determine the cause of these small but significant absolute differences between measurements obtained by the FI and HT.

Validating prediction equations for mid-arm circumference measurements in adults: National Health and Nutrition Examination Survey, 2001-2012.

BackgroundAccurate measurement of blood pressure (BP) requires choosing an appropriate BP cuff size. ObjectivesThe objective of this study was to examine the validity of regression equations to predict mid-arm circumference (mid-AC) using 2001–2012 National Health and Nutrition Examination Survey height and weight data. MethodsNational Health and Nutrition Examination Survey uses a complex multistage probability sample design to represent the civilian, noninstitutionalized US resident population. The sample consisted of 29 745 participants aged 20 years and older. ResultsFor both men and women, the correlations between the predicted and measured mid-AC values were as follows: r=0.91 and 0.92, P<0.001, respectively. For both sexes, the difference between the predicted and measured mid-AC mean values was less than 1.5 cm. The overall percent agreement for selecting the appropriate BP cuff, using the American Heart Association cuff size criteria and comparing the predicted mid-AC values with measured values, was 83.0% for men and 80.0% for women. The percent agreement for small adult cuff was 10.0% for men and 54.0% for women; for adult cuff it was 87.0% for men and 88.0% for women; for large adult cuff it was 82.0% for men and 80.0% for women; and for thigh cuff it was 84.0% for men and 74.0% for women. All agreement statistics were above chance (for men, &ggr;=0.96, and Kendall’s Tau-b=0.73; for women, &ggr;=0.97, and Kendall’s Tau-b=0.76). ConclusionWhen possible, mid-AC should be directly measured for appropriate BP cuffing; however, the results of this validation study suggest that the prediction equations for mid-AC estimations were highly correlated and had an overall 80.0% agreement with measured mid-AC.

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.