CitationWright, Jacqueline D.; Stevens, June; Poole, Charles L.; Flegal, Katherine M.; & Suchindran, Chirayath M. (2010). The Impact of Differences in Methodology and Population Characteristics on the Prevalence of Hypertension in US Adults in 1976-1980 and 1999-2002. American Journal of Hypertension, 23(6), 620-626. PMCID: PMC5774853
AbstractBackground: Results from the National Health and Nutrition Examination Survey (NHANES) indicate that hypertension prevalence declined by 9% points from 34% in 1976-1980 to 25% in 1999-2002 in adults 20-74 years. The purpose of this study was to estimate the impact on hypertension prevalence of measurement error and selected risk factors.
Methods: Using cross-sectional survey data from NHANES, we estimated the effect on hypertension of incorrect blood pressure (BP) cuff size and zero end-digit preference and the effect of changes in the distribution of age, body mass index (BMI), sex, race-ethnicity, smoking, and education. The analytic sample of persons 20-74 years consisted of 11,563 from 1976-1980 and 7,901 from 1999-2002 NHANES. Covariate-adjusted prevalences were calculated using log-linear regression models to produce predictive margins.
Results: After adjustment to age, BMI, sex, race-ethnicity, smoking, and education, the prevalence difference became higher, changing from -9% (95% confidence interval (CI): -11, -6) to -14% (95 CI: -17, -11). After adjustment to these risk factors and correction for measurement error the prevalence difference was -9% (95 CI: -11, -6).
Conclusions: Measurement error, mainly from cuff size differences, inflated the temporal decline in hypertension prevalence. The results indicate that age, sex, race-ethnicity, smoking, or education did not fully explain the lower prevalence of measured hypertension in all BMI groups and suggest that a change in some unmeasured factor or factors contributed to the decline.
Reference TypeJournal Article
Journal TitleAmerican Journal of Hypertension
Author(s)Wright, Jacqueline D.
Poole, Charles L.
Flegal, Katherine M.
Suchindran, Chirayath M.