Trends and cardiovascular mortality effects of state-level blood pressure and uncontrolled hypertension in the United States.
Abstract
Background— Blood pressure is an important risk factor for cardiovascular disease and mortality and has lifestyle and healthcare determinants that vary across states. Only self-reported hypertension status is measured at the state level in the United States. Our aim was to estimate levels and trends in state-level mean systolic blood pressure (SBP), the prevalence of uncontrolled systolic hypertension, and cardiovascular mortality attributable to all levels of higher-than-optimal SBP. Methods and Results— We estimated the relationship between actual SBP/uncontrolled hypertension and self-reported hypertension, use of blood pressure medication, and a set of health system and sociodemographic variables in the nationally representative National Health and Nutrition Examination Survey. We applied this relationship to identical variables from the Behavioral Risk Factor Surveillance System to estimate state-specific mean SBP and uncontrolled hypertension. We used the comparative risk assessment methods to estimate cardiovascular mortality attributable to higher-than-optimal SBP. In 2001–2003, age-standardized uncontrolled hypertension prevalence was highest in the District of Columbia, Mississippi, Louisiana, Alabama, Texas, Georgia, and South Carolina (18% to 21% for men and 24% to 26% for women) and lowest in Vermont, Minnesota, Connecticut, New Hampshire, Iowa, and Colorado (15% to 16% for men and ≈21% for women). Women had a higher prevalence of uncontrolled hypertension than men in every state by 4 (Arizona) to 7 (Kansas) percentage points. In the 1990s, uncontrolled hypertension in women increased the most in Idaho and Oregon (by 6 percentage points) and the least in the District of Columbia and Mississippi (by 3 percentage points). For men, the worst-performing states were New Mexico and Louisiana (decrease of 0.6 and 1.3 percentage points), and the best-performing states were Vermont and Indiana (decrease of 4 and 3 percentage points). Age-standardized cardiovascular mortality attributable to higher-than-optimal SBP ranged from 200 to 220 per 100 000 (Minnesota and Massachusetts) to 360 to 370 per 100 000 (District of Columbia and Mississippi) for women and from 210 per 100 000 (Colorado and Utah) to 370 per 100 000 (Mississippi) and 410 per 100 000 (District of Columbia) for men. Conclusions— Lifestyle and pharmacological interventions for lowering blood pressure are particularly needed in the South and Appalachia, and with emphasis on control among women. Self-reported data on hypertension diagnosis from the Behavioral Risk Factor Surveillance System can be used to obtain unbiased state-level estimates of blood pressure and uncontrolled hypertension as benchmarks for priority setting and for designing and evaluating intervention programs.
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The large numbers of deaths attributable to high blood pressure were related to high exposure levels, particularly in women.
“The large numbers of deaths attributable to high blood pressure were related to high exposure levels, particularly in women [39].”
From The Preventable Causes of Death in the United States: Comparative Risk Assessment of Dietary, Lifestyle, and Metabolic Risk Factors (2009) · cites this paper as [39]
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- Authors
- Ezzati, M., Oza, S., Danaei, G., & Murray, C. J. L.
- Affiliations
- Harvard University (US)
- Venue
- Circulation
- Published
- 2008-02-19
- Volume
- 117
- Issue
- 7
- Pages
- 905-914
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2107045578
- Cited by
- 158
- References
- 30
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 2 · 2023: 2 · 2022: 4 · 2021: 6 · 2020: 5 · 2019: 6 · 2018: 10 · 2017: 7 · 2016: 11 · 2015: 11 · 2014: 11 · 2013: 13 · 2012: 12
- FWCI
- 11.80
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Centers for Disease Control and Prevention
- U.S. Public Health Service (U36 CCU300430-23)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Keywords
- uncontrolled hypertension, systolic blood pressure, cardiovascular mortality, state-level variation, hypertension prevalence trends, attributable mortality, sex differences, sociodemographic factors, health system factors, cardiovascular risk factors, United States states, NHANES, Behavioral Risk Factor Surveillance System, comparative risk assessment, health disparities
- MeSH terms
- Adult, Aged, Antihypertensive Agents, Cardiovascular Diseases, Drug Utilization, Female, Health Promotion, Humans, Hypertension, Life Style, Male, Middle Aged, Morbidity, Nutrition Surveys, Obesity, Risk Factors, Self Disclosure, Systole, United States, Health Behavior, Prevalence, Age Distribution, Sex Distribution, Behavioral Risk Factor Surveillance System
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