Elevated blood pressure among U.S. adults with diabetes, 1988–19941

https://doi.org/10.1016/S0749-3797(01)00399-3Get rights and content

Abstract

Background: Recent guidelines and clinical trial results emphasize the importance of controlling blood pressure among people with diabetes. We estimated the prevalence of elevated blood pressure among U.S. adults with diagnosed diabetes, and examined the extent to which elevated blood pressure is being treated and controlled.

Methods: The Third National Health and Nutrition Examination Survey (1988–1994), a probability survey of the civilian, non-institutionalized population of the United States, consisted of an interview and physical examination, which included blood pressure measurement. Survey participants included 1507 adults (aged ≥18 years) with self-reported diabetes. Among people with self-reported diabetes, we estimated elevated blood pressure (mean blood pressure of ≥130/85 mm Hg or use of antihypertensive medication); awareness (prior diagnosis of hypertension); treatment (antihypertensive medication use); and control (mean blood pressure of <130/85 or <140/90).

Results: In the 1988–1994 period, 71% (95% confidence interval [CI]=±4.4%) of all U.S. adults with diabetes had elevated blood pressure. The prevalence of elevated blood pressure increased with age and was high among both men and women and among Mexican Americans, non-Hispanic blacks, and non-Hispanic whites. Among those with elevated blood pressure, 71% (95% CI=±4.1%) were aware and 57% (95% CI=±4.2%) were treated, but only 12% (95% CI=±3.2%) had mean blood pressure <130/85 and 45% (95% CI=±4.9%) had mean blood pressure <140/90. Control of blood pressure was least common among older people.

Conclusions: All people with diabetes—regardless of age, gender, and race and ethnicity—may benefit from efforts to prevent hypertension. The control of elevated blood pressure is inadequate and broad-based efforts are needed to improve blood pressure control.

Section snippets

Background

In 1997, the sixth report of the Joint National Commission on the Detection, Evaluation, and Treatment of High Blood Pressure (JNC-VI),1 for the first time, incorporated a risk-stratification scheme into treatment algorithms for high blood pressure that included the presence of cardiovascular risk factors, such as diabetes. For people with diabetes, the JNC-VI treatment guidelines recommended that lifestyle modifications and anti-hypertensive drug therapy be initiated for blood pressure ≥130/85

Methods

The National Center for Health Statistics of the Centers for Disease Control and Prevention conducted the NHANES III between 1988 and 1994 on a representative sample of the civilian, non-institutionalized population of the United States.9 The survey included an interview and a limited examination within the home, followed by a more extensive physical examination in a mobile examination center (MEC). Of the 39,695 sampled people, 86% (33,994) agreed to be interviewed and examined in their home

Prevalence and type of elevated blood pressure

Among U.S. adults with diabetes (9.1 million), 71.0% (6.4 million) had elevated blood pressure (i.e., blood pressure ≥130/85 mm Hg or current use of prescription medication for hypertension) (Table 1). The prevalence of elevated blood pressure was high among all age groups, but it increased with age, from 39.6% among people aged 18 to 44 years, to 71.5% among people aged 45 to 64 years, to 83.5% among people aged ≥65 years. Although the estimated prevalence of elevated blood pressure was

Conclusions

During 1988 to 1994, 71% of the U.S. adult population with diabetes had elevated blood pressure. The prevalence of elevated blood pressure increased with age and was high among both men and women and among Mexican Americans, non-Hispanic blacks, and non-Hispanic whites. Because the NHANES III was conducted prior to JNC-VI treatment recommendations, these data reflect how far we need to go rather than how well standards of care regarding detection, treatment, and control were being met at the

References (29)

  • W.J Elliott et al.

    Cost-effectiveness of the lower treatment goal (of JNC VI) for diabetic hypertensive patients

    Arch Intern Med

    (2000)
  • National Center for Health Statistics. Third National Health and Nutrition Examination Survey, 1988–1994, reference...
  • The fifth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC V)

    Arch Intern Med

    (1993)
  • The 1988 report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure

    Arch Intern Med

    (1988)
  • Cited by (118)

    • Thresholds and Targets for Hypertension Management in Adults With Type 2 Diabetes Should Remain at 130/80 mmHg: What's the Evidence?

      2018, Canadian Journal of Diabetes
      Citation Excerpt :

      Hypertension is a common health problem affecting 40% of the world's population over the age of 25, approximately 1 billion people (5) and is responsible for about 9.4 million deaths every year (6). The National Health Awareness Evaluative Survey (NHANES) data from the United States found that 71% of people with diabetes have hypertension (7). Patients with type 2 diabetes patients are more likely to have CAD, and those with uncontrolled hypertension in addition to diabetes are likely to have angiographic evidence of obstructive coronary artery disease of over 50% in more than half of patients, compared to one-third of those without hypertension (8).

    View all citing articles on Scopus
    1

    The full text of this article is available via AJPM Online at http://www.elsevier.com/locate/ajpmonline.

    View full text