Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-24 (of 24 Records) |
Query Trace: Ostchega Y[original query] |
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Differences in hypertension and stage II hypertension by demographic and risk factors, obtained by two different protocols in US adults: National Health and Nutrition Examination Survey, 2017-2018
Ostchega Y , Hughes JP , Kit B , Chen TC , Nwankwo T , Commodore-Mensah Y , Graber JE , Nguyen DT . Am J Hypertens 2022 35 (7) 619-626 OBJECTIVE: To compare prevalence of hypertension and stage II hypertension assessed by two blood pressure observation protocols. METHODS: Participants aged 18 years and older (n = 4,689) in the National Health and Nutrition Examination Survey (NHANES 2017-2018) had their blood pressure (BP) measured following two protocols: the legacy auscultation protocol [AP] and oscillometric protocol [OP]. The order of protocols was randomly assigned. Prevalence estimates for hypertension (BP 130/80 mm Hg or use of medication for hypertension) and stage II hypertension (BP 140/90 mm Hg) were determined overall, by demographics, and by risk factors for each protocol. Ratios (OP% AP%) and Kappa statistics were calculated. RESULTS: Age-adjusted hypertension prevalence was 44.5% (95% CI: 41.1%-48.0%) using OP and 45.1% (95%CI: 41.5%-48.7%) using AP, prevalence ratio=0.99, (95% CI=0.94-1.04)). Age-adjusted Stage II hypertension prevalence was 15.8% (95% CI: 13.6%-18.2%) using AP and 17.1% (95% CI: 14.7%-19.7%) using OP, prevalence ratio=0.92, (95% CI=0.81-1.04)). For both hypertension and Stage II hypertension, the prevalence ratios by demographics and by risk factors all included unity in their 95% CI, except for Stage II hypertension in adults 60+ years (ratio: 0.88 (95% CI: 0.78-0.98)). Kappa for agreement between protocols for hypertension and stage II hypertension were 0.75 (95% CI=0.71-0.79) and 0.67 (95% CI=0.61-0.72), respectively. CONCLUSIONS: In adults and for nearly all subcategories there were no significant differences in prevalence of hypertension and stage II hypertension between protocols, indicating that protocol change may not affect the national prevalence estimates of hypertension and stage II hypertension. |
Differences in hypertension prevalence and hypertension control by urbanization among adults in the United States, 2013-2018
Ostchega Y , Hughes JP , Zhang G , Nwankwo T , Graber J , Nguyen DT . Am J Hypertens 2021 35 (1) 31-41 OBJECTIVE: To examine the associations between urbanization and hypertension, stage II hypertension, and hypertension control. METHODS: Data on 16,360 U.S. adults aged 18 years or older from the 2013-2018 National Health and Nutrition Examination Survey (NHANES) were used to estimate the prevalence of hypertension (blood pressure (BP) ≥130/80 mm Hg or use of medication for hypertension), stage II hypertension (BP ≥140/90 mm Hg), and hypertension control (BP < 130/80 mm Hg among hypertensives) by urbanization, classified by levels of metropolitan statistical areas as large MSAs (population ≥ 1,000,000), medium to small MSAs (population 50,000-999,999), and non-MSAs (population <50,000)). RESULTS: All prevalence ratios (PRs) were compared with large MSAs and adjusted for demographics and risk factors. The PRs of hypertension were 1.07 (95% CI= 0.99-1.14) for adults residing in medium to small MSAs and 1.06 (95% CI=0.99- 1.13) for adults residing in non-MSAs, For stage II hypertension, the PRs were higher for adults residing in medium to small MSAs 1.21 (95% CI =1.06-1.36) but not for adults residing in non-MSAs 1.06 (95% CI= 0.88-1.29). For hypertension control, the PRs were 0.96 (95% CI=0.91-1.01) for adults residing in medium to small MSAs and 1.00 (95% CI=0.93-1.06) for adults residing in non-MSAs. CONCLUSION: Among U.S. adults, urbanization was associated with stage II hypertension. |
Developing equations to predict waist circumference measurements based on the National Heart, Lung, and Blood Institute Method from the World Health Organization Method
Ostchega Y , Zhang G , Gu Q , Isfahani NS , Hughes JP , Schall J . Ann Epidemiol 2020 53 21-26 e1 OBJECTIVE: To convert waist circumference (WC) measurements obtained by World Health Organization (WHO-WC) method to National Heart, Lung, and Blood Institute (NHLBI-WC) method. METHODS: During 2016, National Health and Nutrition Examination Survey participants aged 20 and older had two different WC measurements taken (n=2,405). Mean differences in WC between the NHLBI-WC and WHO-WC measurements were calculated. Multivariable prediction models were developed to predict NHLBI-WC from the measured WHO-WC. Sensitivity and specificity of abdominal obesity classification (AOC) were calculated for the measured WHO-WC and the predicted NHLBI-WC. Kappa coefficients were calculated to evaluate the agreements between AOC derived from NHLBI-WC and from WHO-WC and the predicted NHLBI-WC. RESULTS: The mean differences between NHLBI-WC and WHO-WC were 0.8 cm for males and 3.2 cm for females (p ≤ 0.05). Sensitivity of AOC for measured WHO-WC was 93% for males and 87% for females, and specificity of AOC was ≥ 97% for both genders. Sensitivity and specificity of AOC for predicted NHLBI-WC were ≥ 95% for both genders. The AOC derived from the predicted NHLBI-WC had higher agreements for both genders. CONCLUSION: The prediction equations provided may be used to predict NHLBI-WC from WHO-WC for comparability in WC estimates across studies. |
Comparison of three devices for 24-hour ambulatory blood pressure monitoring in a nonclinical environment through a randomized trial
Nwankwo T , Coleman King SM , Ostchega Y , Zhang G , Loustalot F , Gillespie C , Chang TE , Begley EB , George MG , Shimbo D , Schwartz JE , Muntner P , Kronish IM , Hong Y , Merritt R . Am J Hypertens 2020 33 (11) 1021-1029 BACKGROUND: The U.S. Preventive Services Task Force recommends the use of 24-hour ambulatory blood pressure monitoring (ABPM) as part of screening and diagnosis of hypertension. The optimal ABPM device for population-based surveys is unknown. OBJECTIVE: Among three ABPM devices, we compared the proportion of valid BP readings, mean awake and asleep BP readings, differences between awake ABPM readings and initial standardized BP readings, and sleep experience. RESULTS: The proportions of valid blood pressure readings were not different among the three devices ( p > 0.45). Mean awake and asleep systolic BP were significantly higher for STO device (WA vs. STO vs. SL: 126.65 mmHg, 138.09 mmHg, 127.44 mmHg; 114.34 mmHg, 120.34 mmHg, 113.13 mmHg; p <0.0001 for both). The difference between the initial average standardized mercury systolic BP readings and the ABPM mean awake systolic BP was larger for STO device (WA vs. STO. vs. SL: -5.26 mmHg, -16.24 mmHg, -5.36 mmHg; p <0.0001); diastolic BP mean differences were ~ -6 mmHg for all three devices ( p =0.6). Approximately 55% of participants reported that the devices interfered with sleep; however, there were no sleep differences across the devices (p >0.4 for all). CONCLUSION: Most of the participants met the threshold of 70% valid readings over 24 hours. Sleep disturbance was common but did not interfere with completion of measurement in most of the participants. |
Calibrating local population-based blood pressure data from NYC HANES 2013-2014
Kanchi R , Perlman S , Ostchega Y , Chamany S , Shimbo D , Chernov C , Thorpe LE . J Urban Health 2019 96 (5) 720-725 New York City Health and Nutrition Examination Survey (NYC HANES) was a population-based cross-sectional survey of NYC adults conducted twice, in 2004 and again in 2013-2014, to monitor the health of NYC adults 20 years or older. While blood pressure was measured in both surveys, an auscultatory mercury sphygmomanometer was used to measure blood pressure in clinics in 2004, and an oscillometric LifeSource UA-789AC monitor was used in homes in 2013-2014. To assess comparability of blood pressure results across both surveys, we undertook a randomized study comparing blood pressure (BP) readings by the two devices. Blood pressure measuring protocols followed the 2013 Association for the Advancement in Medical instrumentation guidelines for non-invasive blood pressure device. Data from 167 volunteers were analyzed for this purpose.Paired t tests were used to test for significant difference in mean systolic and diastolic blood pressure between devices for overall and by mid-arm circumference categories. To test for systematic differences between the two devices, we generated Bland-Altman graphs. Sensitivity, specificity, and Kappa statistics were calculated to assess between-device agreement for high (>/= 130/80 mmHg) and not high (< 130/80 mmHg) blood pressure, with mercury set as the reference.Systolic and diastolic blood pressure measured by LifeSource UA-789AC were on average 2.0 and 1.1 mmHg higher, respectively, than those of the mercury sphygmomanometer systolic and diastolic blood pressure readings (P < 0.05). Sensitivity was 81%, specificity was 96%, and the Kappa coefficient was 75%. The Bland-Altman graphs showed that the between-device difference did not vary as a function of the average of the two devices for systolic blood pressure and was larger in the lower and upper ends for diastolic blood pressure. Given the observed differences in systolic and diastolic blood pressure readings between the two blood pressure measurement approaches, we calibrated NYC HANES 2013-2014 blood pressure data by predicting mercury blood pressure values from LifeSource blood pressure values. The mean systolic and diastolic blood pressure in NYC HANES 2013-2014 were lower when data were calibrated. |
Blood pressure assessment in adults in clinical practice and clinic-based research: JACC Scientific Expert Panel
Muntner P , Einhorn PT , Cushman WC , Whelton PK , Bello NA , Drawz PE , Green BB , Jones DW , Juraschek SP , Margolis KL , Miller ER3rd , Navar AM , Ostchega Y , Rakotz MK , Rosner B , Schwartz JE , Shimbo D , Stergiou GS , Townsend RR , Williamson JD , Wright JTJr , Appel LJ , National Heart Lung Blood Institute Working Group . J Am Coll Cardiol 2019 73 (3) 317-335 The accurate measurement of blood pressure (BP) is essential for the diagnosis and management of hypertension. Restricted use of mercury devices, increased use of oscillometric devices, discrepancies between clinic and out-of-clinic BP, and concerns about measurement error with manual BP measurement techniques have resulted in uncertainty for clinicians and researchers. The National Heart, Lung, and Blood Institute of the U.S. National Institutes of Health convened a working group of clinicians and researchers in October 2017 to review data on BP assessment among adults in clinical practice and clinic-based research. In this report, the authors review the topics discussed during a 2-day meeting including the current state of knowledge on BP assessment in clinical practice and clinic-based research, knowledge gaps pertaining to current BP assessment methods, research and clinical needs to improve BP assessment, and the strengths and limitations of using BP obtained in clinical practice for research and quality improvement activities. |
Mean mid-arm circumference and blood pressure cuff sizes for US children, adolescents and adults: National Health and Nutrition Examination Survey, 2011-2016
Ostchega Y , Hughes JP , Nwankwo T , Zhang G . Blood Press Monit 2018 23 (6) 305-311 BACKGROUND: Measuring blood pressure (BP) requires an appropriate BP cuff size given measured mid-arm circumference (mid-AC). OBJECTIVE: To provide mid-AC means and percentiles for US population aged more than 3 years and examine the frequency distribution of mid-AC cuffed by Baum and Welch Allyn cuff systems. PATIENTS AND METHODS: The 2011-2016 National Health and Nutrition Examination Survey, a cross-sectional survey, was used to estimate mean mid-AC (n=24 723). RESULTS: Mean mid-AC did not differ from 2011 to 2016 (31.0 vs. 31.3 cm, P>0.05). During 2011-2016, mean mid-AC was greater for males than females (32.0 vs. 30.4 cm, P<0.001) and was largest among adults 40-49 years (34.0 cm). Non-Hispanic Black persons had the largest mean mid-AC (32.0 cm) and non-Hispanic Asian persons the smallest (28.4 cm). Increased BMI was associated with increased mean mid-AC for those 3-19 years (normal, 22.0 cm and obese, 31.5 cm, P<0.001) and more than 20 years (normal, 28.2 cm and obese, 37.8 cm, P<0.001). Among those aged 8-17 years, high BP status was associated with a larger mean mid-AC (normotensive 26.1 cm vs. high BP 28.2 cm, P=0.001). Among adults aged 18 years and older, hypertension status was associated with a larger mean mid-AC (normotensive 32.4 cm vs. hypertensive 34.2 cm, P<0.001). Among those aged 12-19 years, 13.0% required a Baum large cuff (35-46.9 cm mid-AC) and 21.7% required a Welch Allyn large cuff (32-39.9 cm mid-AC). Among those aged more than 20 years, 33.2% required a Baum large cuff, 48.2% required a Welch Allyn large cuff, 1.3% required a Baum extra-large cuff (44-66 cm mid-AC), and 9.5% required a Welch Allyn extra-large cuff (40-55 cm mid-AC). CONCLUSION: Currently, BP is obtained in clinic, pharmacy, home, and ambulatory setting using single or multiple cuffs. National Health and Nutrition Examination Survey mid-AC data should be considered for accurate cuffing avoiding cuff hypertension or hypotension. |
Factors associated with hypertension control in U.S. adults using 2017 ACC/AHA Guidelines: National Health and Nutrition Examination Survey 1999-2016
Ostchega Y , Zhang G , Hughes J , Nwankwo T . Am J Hypertens 2018 31 (8) 886-894 Background: Factors and trends associated with hypertension control (BP <130/<80 mm Hg) and mean blood pressure (BP) among hypertensive adults (BP >/=130/80 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% to 26.3%, P<0.001) and then plateaued. For men with hypertension, systolic BP decreased from 1999-2000 to 2011-2012 (135.7 mmHg to 132.8 mmHg, P<0.001) and then increased to 135.3 mmHg in 2015-2016 (P<0.001). For women with hypertension, systolic BP decreased from 1999-2000 to 2009-2010 (139.7 mmHg to 131.9 mmHg; p<.001) and then increased to 134.4 mmHg in 2015-2016 (P = 0.003). Diastolic BP decreased from 1999-2000 to 2015-2016 (men 79.1 mmHg to 75.5 mmHg and women 76.4 mmHg to 73.7 mmHg, P<.001 for both). In 2011 to 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%C I=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. |
Factors associated with home blood pressure monitoring among US adults: National Health and Nutrition Examination Survey, 2011-2014
Ostchega Y , Zhang G , Kit BK , Nwankwo T . Am J Hypertens 2017 30 (11) 1126-1132 BACKGROUND: Home blood pressure monitoring (HBPM) has a substantial role in hypertension management and control. METHODS: Cross-sectional data for noninstitutionalized US adults 18 years and older (10,958) from the National Health and Nutrition Examination Survey (NHANES), years 2011-2014, were used to examine factors related to HBPM. RESULTS: In 2011-2014, estimated 9.5% of US adults engaged in weekly HBPM, 7.2% engaged in monthly HBPM, 8.0% engaged in HBPM less than once a month, and 75.3% didn't engage any HBPM. The frequency of HBPM increased with age, body mass index, and the number of health care visits (all, P < 0.05). Also, race/ethnicity (Non-Hispanic Blacks and non-Hispanic Asians), health insurance, diagnosed with diabetes, told by a health care provider to engage in HBPM, and diagnosed as hypertensive, were all associated with more frequent HBPM (P < 0.05). Adjusting for covariates, hypertensives who were aware of, treated for, and controlled engaged in more frequent HBPM compared to their respective references: unaware (odds ratio [OR] = 2.00, 95% confidence interval [CI] = 1.53-2.63), untreated (OR = 1.99, 95% CI = 1.52-2.60), and uncontrolled (OR = 1.42, 95% CI = 1.13-1.82). Hypertensive adults (aware/unaware, treated/untreated, or controlled/uncontrolled), who received providers' recommendations to perform HBPM, were more likely to do so compared to those who did not receive recommendations (OR = 8.04, 95% CI = 6.56-9.86; OR = 7.98, 95% CI = 6.54-9.72; OR = 8.75, 95% CI = 7.18-10.67, respectively). CONCLUSIONS: Seventeen percent of US adults engaged in monthly or more frequent HBPM and health care providers' recommendations to engage in HBPM have a significant impact on the frequency of HBPM. |
Blood pressure cuff comparability study
Ostchega Y , Nwankwo T , Zhang G , Chiappa M . Blood Press Monit 2016 21 (6) 345-351 BACKGROUND: Manufacturer-supplied blood pressure (BP) cuffs are part of the automatic oscillometric BP devices algorithm. MATERIALS AND METHODS: This 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. RESULTS: The 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). CONCLUSION: Using a BC with the Omron could result in higher systolic BP readings and higher diastolic BP readings with the adult cuff size. |
Development and validation of a hypertension prevalence estimator tool for use in clinical settings
Ritchey M , Yuan K , Gillespie C , Zhang G , Ostchega Y . J Clin Hypertens (Greenwich) 2016 18 (8) 750-61 Health systems are well positioned to identify and control hypertension among their patients. However, almost one third of US adults with uncontrolled hypertension are currently receiving medical care and are unaware of being hypertensive. This study describes the development and validation of a tool that health systems can use to compare their reported hypertension prevalence with their expected prevalence. Tool users provide the number of patients aged 18 to 85 years treated annually, stratified by sex, age group, race/ethnicity, and comorbidity status. Each stratum is multiplied by stratum-specific national prevalence estimates and the amounts are summed to calculate the number of expected hypertensive patients. The tool's validity was assessed by applying samples from cohorts with known hypertension prevalence; small differences in expected vs actual prevalence were identified (range, -3.3% to 0.6%). This tool provides clinically useful hypertension prevalence estimates that health systems can use to help inform hypertension management quality improvement efforts. |
Validating prediction equations for mid-arm circumference measurements in adults: National Health and Nutrition Examination Survey, 2001-2012
Nwankwo T , Ostchega Y , Zhang G , Hughes JP . Blood Press Monit 2015 20 (3) 157-63 BACKGROUND: Accurate measurement of blood pressure (BP) requires choosing an appropriate BP cuff size. OBJECTIVES: The 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. METHODS: National 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. RESULTS: For 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, gamma=0.96, and Kendall's Tau-b=0.73; for women, gamma=0.97, and Kendall's Tau-b=0.76). CONCLUSION: When 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. |
Prevalence of and trends in dyslipidemia and blood pressure among US children and adolescents, 1999-2012
Kit BK , Kuklina E , Carroll MD , Ostchega Y , Freedman DS , Ogden CL . JAMA Pediatr 2015 169 (3) 272-9 IMPORTANCE: Recent national data suggest there were improvements in serum lipid concentrations among US children and adolescents between 1988 and 2010 but an increase in or stable blood pressure (BP) during a similar period. OBJECTIVE: To describe the prevalence of and trends in dyslipidemia and adverse BP among US children and adolescents. DESIGN: The National Health and Nutrition Examination Survey, a cross-sectional survey. Setting: Noninstitutionalized US population. PARTICIPANTS: Children and adolescents aged 8 to 17 years with measured lipid concentrations (n = 1482) and BP (n = 1665). MAIN OUTCOMES AND MEASURES: Adverse concentrations of total cholesterol (TC) (≥200 mg/dL), high-density lipoprotein cholesterol (HDL-C) (<40 mg/dL), and non-HDL-C (≥145 mg/dL) (to convert TC, HDL-C, and non-HDL-C to millimoles per liter, multiply by 0.0259) and high or borderline BP were examined. Definitions of BP were informed by the Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents by the National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. Analyses of linear trends in dyslipidemias and BP were conducted overall and separately by sex across 7 periods (1999-2000, 2001-2002, 2003-2004, 2005-2006, 2007-2008, 2009-2010, and 2011-2012). RESULTS: In 2011-2012, 20.2% (95% CI, 16.3-24.6) of youths had an adverse concentration of TC, HDL-C, or non-HDL-C and 11.0% (95% CI, 8.8-13.4) had either high or borderline BP. The prevalences of adverse concentrations decreased between 1999-2000 and 2011-2012 for TC (10.6% [95% CI, 8.3-13.2] vs 7.8% [95% CI, 5.7-10.4]; P = .006), HDL-C (17.9% [95% CI, 15.0-21.0] vs 12.8% [95% CI, 9.8-16.2]; P = .003), and non-HDL-C (13.6% [95% CI, 11.3-16.2] vs 8.4% [95% CI, 5.9-11.5]; P < .001). There was a decrease in high BP between 1999-2000 (3.0% [95% CI, 2.0-4.3]) and 2011-2012 (1.6% [95% CI, 1.0-2.4]) (P = .003). There was no change from 1999-2000 to 2011-2012 in borderline high BP (7.6% [95% CI, 5.8-9.8] vs 9.4% [95% CI, 7.2-11.9]; P = .90) or either high or borderline high BP (10.6% [8.4-13.1] vs 11.0% [95% CI, 8.8-13.4]; P = .26). CONCLUSIONS AND RELEVANCE: In 2011-2012, approximately 1 in 5 children and adolescents aged 8 to 17 years had an adverse lipid concentration of TC, HDL-C, or non-HDL-C and slightly more than 1 in 10 had either borderline high or high BP. The prevalence of dyslipidemia modestly decreased between 1999-2000 and 2011-2012, but either high or borderline high BP remained stable. The reasons for these trends require further study. |
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
Ostchega Y , Hughes JP , Prineas RJ , Zhang G , Nwankwo T , Chiappa MM . Blood Press Monit 2014 19 (1) 26-31 BACKGROUND: Accurately measuring blood pressure (BP) requires choosing an appropriate BP cuff size. OBJECTIVES: This 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. METHODS: NHANES 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. RESULTS: During 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. CONCLUSION: During 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. |
Mean mid-arm circumference and blood pressure cuff sizes for US adults: National Health and Nutrition Examination Survey, 1999-2010
Ostchega Y , Hughes JP , Zhang G , Nwankwo T , Chiappa MM . Blood Press Monit 2013 18 (3) 138-43 BACKGROUND: Accurately measuring blood pressure (BP) requires choosing an appropriate BP cuff size. OBJECTIVES: This 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. METHODS: NHANES 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. RESULTS: Data 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. CONCLUSION: There 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, approximately 45% of adult men and approximately 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. |
Home blood pressure monitoring and hypertension status among US adults: the National Health and Nutrition Examination Survey (NHANES), 2009-2010
Ostchega Y , Berman L , Hughes JP , Chen TC , Chiappa MM . Am J Hypertens 2013 26 (9) 1086-92 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. |
Abdominal obesity, body mass index, and hypertension in US adults: NHANES 2007-2010
Ostchega Y , Hughes JP , Terry A , Fakhouri TH , Miller I . Am J Hypertens 2012 25 (12) 1271-8 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/m(2)) 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. (American Journal of Hypertension, (2012); doi:10.1038/ajh.2012.120.) |
United States national prevalence of electrocardiographic abnormalities in black and white middle-age (45- to 64-year) and older (≥65-year) adults (from the Reasons for Geographic and Racial Differences in Stroke study)
Prineas RJ , Le A , Soliman EZ , Zhang ZM , Howard VJ , Ostchega Y , Howard G . Am J Cardiol 2012 109 (8) 1223-8 A United States national sample of 20,962 participants (57% women, 44% blacks) from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study provided general population estimates for electrocardiographic (ECG) abnormalities among black and white men and women. The participants were recruited from 2003 to 2007 by random selection from a commercially available nationwide list, with oversampling of blacks and those from the stroke belt, with a cooperation rate of 49%. The measurement of risk factors and 12-lead electrocardiograms (centrally coded using Minnesota code criteria) showed 28% had ≥1 major ECG abnormality. The prevalence of abnormalities was greater (≥35%) for those ≥65 years old, with no differences between blacks and whites. However, among men <65 years, blacks had more major abnormalities than whites, most notably for atrial fibrillation, major Q waves, and left ventricular hypertrophy. Men generally had more ECG abnormalities than women. The most common ECG abnormalities were T-wave abnormalities. The average heart rate-corrected QT interval was longer in women than in men, similar in whites and blacks, and increased with age. However, the average heart rate was greater in women than in men and in blacks than in whites and decreased with age. The prevalence of ECG abnormalities was related to the presence of hypertension, diabetes, blood pressure, and age. In conclusion, black men and women in the United States have a significantly greater prevalence of ECG abnormalities than white men and women at age 45 to 64 years; however, these proportions, although larger, tended to equalize or reverse after age 65. |
Resting pulse rate reference data for children, adolescents, and adults: United States, 1999-2008
Ostchega Y , Porter KS , Hughes J , Dillon CF , Nwankwo T . Natl Health Stat Report 2011 (41) 1-16 OBJECTIVE: This report presents national reference data on resting pulse rate (RPR), for all ages of the U.S. population, from 1999-2008. METHODS: During 1999-2008, 49,114 persons were examined. From this, a normative sample comprising 35,302 persons was identified as those who did not have a current medical condition or use a medication that would affect the RPR. RPR was obtained after the participant had been seated and had rested quietly for approximately 4 minutes. RESULTS: RPR is inversely associated with age. There is a mean RPR of 129 beats per minute (standard error, or SE, 0.9) at less than age 1 year, which decreases to a mean RPR of 96 beats/min (SE 0.5) by age 5, and further decreases to 78 beats/min (SE 0.3) in early adolescence. The mean RPR in adulthood plateaus at 72 beats/min (SE 0.2) (p < 0.05 for trend). In addition, there is a significant gender difference, with the male pulse rate plateauing in early adulthood, while the female resting pulse plateaus later when middle-aged. There are two exceptions, that is, infants under age 1 year and adults aged 80 and over, when the mean RPR is statistically and significantly higher in females than in males (females under age 20 have an RPR of 90 beats/min, SE 0.3, and males under age 20 have an RPR of 86 beats/min, SE 0.3, p <0.05; females aged 20 and over have an RPR of 74 beats/min, SE 0.2, and males aged 20 and over have an RPR of 71 beats/min, SE 0.3, p <0.05). After controlling for age effects, non-Hispanic black males have a significantly (p <0.001) lower mean RPR (74 beats/min) than non-Hispanic white males (77 beats/min) and Mexican-American males (76 beats/min). Among females, non-Hispanic black females (79 beats/min) and Mexican-American females (79 beats/min) had statistically and significantly (p < 0.01) lower mean RPRs compared with non-Hispanic white females (80 beats/min). Among males, the prevalence of clinically defined tachycardia (abnormally fast heart rate, RPR 100 beats/min) is 1.3% (95% CI = 1.1-1.7), and the prevalence of clinically defined bradycardia (abnormally slow heart rate, RPR < 60 beats/min) is 15.2% (95% CI = 14.1-16.4). For adult females, these prevalences are 1.9% (95% CI = 1.6-2.3) for clinical tachycardia and 6.9% (95% CI = 6.2-7.8) for clinical bradycardia. Controlling for age, males have higher odds (2.43, 95% CI = 2.09-2.83) of having bradycardia, and notably lower odds (0.71, 95% CI = 0.52-0.97) of having tachycardia than women. CONCLUSIONS: The data provides current, updated population-based percentiles of RPR, which is one of the key vital signs routinely measured in clinical practice. |
Mean systolic and diastolic blood pressure in adults aged 18 and over in the United States, 2001-2008
Wright JD , Hughes JP , Ostchega Y , Yoon SS , Nwankwo T . Natl Health Stat Report 2011 (35) 1-22, 24 OBJECTIVE: This report presents estimates for the period 2001-2008 of means and selected percentiles of systolic and diastolic blood pressure by sex, race or ethnicity, age, and hypertension status in adults aged 18 and over. METHODS: Demographic characteristics were collected during a personal interview, and blood pressures were measured during a physician examination. All estimates were calculated using the mean of up to three measurements. The final analytic sample consisted of 19,921 adults aged 18 and over with complete data. Examined sample weights and sample design variables were used to calculate nationally representative estimates and standard error estimates that account for the complex design, using SAS and SUDAAN statistical software. RESULTS: Mean systolic blood pressure was 122 mm Hg for all adults aged 18 and over; it was 116 mm Hg for normotensive adults, 130 mm Hg for treated hypertensive adults, and 146 mm Hg for untreated hypertensive adults. Mean diastolic blood pressure was 71 mm Hg for all adults 18 and over; it was 69 mm Hg for normotensive adults, 75 mm Hg for treated hypertensive adults, and 85 mm Hg for untreated hypertensive adults. There was a trend of increasing systolic blood pressure with increasing age. A more curvilinear trend was seen in diastolic blood pressure, with increasing then decreasing means with age in both men and women. Men had higher mean systolic and diastolic pressures than women. There were some differences in mean blood pressure by race or ethnicity, with non-Hispanic black adults having higher mean systolic and diastolic blood pressures than non-Hispanic white and Mexican-American adults, but these differences were not consistent after stratification by hypertension status and sex. CONCLUSIONS: These estimates of the distribution of blood pressure may be useful for policy makers who are considering ways to achieve a downward shift in the population distribution of blood pressure with the goal of reducing morbidity and mortality related to hypertension. |
Assessing blood pressure accuracy of an aneroid sphygmomanometer in a national survey environment
Ostchega Y , Prineas RJ , Nwankwo T , Zipf G . Am J Hypertens 2010 24 (3) 322-7 BACKGROUND: The "gold standard" employed for obtaining blood pressure (BP) for all the National Health and Nutrition Examination Surveys (NHANES) has been the mercury sphygmomanometer (HgS). Because of environmental concerns, there is a need to explore an alternative to HgS. METHODS: We compared the accuracy of the Welch Allyn 767 wall aneroid sphygmomanometer (AnS) to the HgS in children and adults and by BP cuff sizes. Each participant had three BP measurements per device recorded sequentially. The order of the devices and observer were random. A total of 727 individuals participating in the NHANES participated in the study. RESULTS: The mean AnS readings were not statistically significantly different from those of the HgS with the exception of systolic BP (SBP) in aged 8-17 years (mean difference 1.10, s.d. 4.87). There were no statistically significantly different by BP cuff sizes. Agreement for the prevalence of hypertension (BP ≥140 systolic or diastolic ≥90 mm Hg) was above chance (kappa = 0. 81; sensitivity = 81%; specificity = 98%) with AnS readings underestimating by 1.66% (18.33 vs. 20%, P > 0.05) compared to the HgS reading. CONCLUSIONS: With the exception of SBP in ages 8-17 years, the AnS device readings were not significantly different from HgS readings by age or BP cuff sizes selection. Agreement for hypertension classification is good. An accurate and well-calibrated AnS could therefore provide an acceptable alternative to the use of a HgS in surveys, although with appropriate caution given the 81% sensitivity with regard to hypertension thresholds that was observed.American Journal of Hypertension (2010). doi:10.1038/ajh.2010.232. |
Recent trends in the prevalence of high blood pressure and its treatment and control, 1999-2008
Yoon SS , Ostchega Y , Louis T . NCHS Data Brief 2010 (48) 1-8 KEY FINDINGS: Data from the National Health and Nutrition Examination Survey There was no significant change in the prevalence of high blood pressure among U.S. adults from 1999-2000 to 2007-2008. This was true for men and women, all age groups, and for non-Hispanic white, non-Hispanic black, and Mexican-American adults. Among U.S. adults with high blood pressure, the percentage that was aware of the condition increased from 69.6% in 1999-2000 to 80.6% in 2007-2008. Among U.S. adults with high blood pressure, the percentage who were taking medication to lower their blood pressure increased from 1999-2000 through 2007-2008. The control of blood pressure increased among U.S. adults with high blood pressure from 1999-2000 through 2007-2008. Increases in control occurred for all subgroups of the population. |
Effects of statins on serum inflammatory markers: the U.S. National Health and Nutrition Examination Survey 1999-2004
Yoon SS , Dillon CF , Carroll M , Illoh K , Ostchega Y . J Atheroscler Thromb 2010 17 (11) 1176-82 AIM: To evaluate the effects of HMG-CoA reductase inhibitor (statin) treatment on serum inflammatory markers using data from the National Health and Nutrition Examination Survey (NHANES 1999-2004). METHODS AND RESULTS: A total of 9,128 individuals aged 40 and older participated in the NHANES. The inflammatory markers studied were white blood cell counts (WBC), high sensitivity C-reactive protein (CRP) and ferritin. Other covariables were: age, gender, race/ethnicity, body mass index, prescription or nonprescription medication use within the previous 30 days (statins, anti-inflammatory drugs, antibiotics). Four analytic groups for drug use were defined: Statin users; AI/Antibiotic users (use of either anti-inflammatory or antibiotic drugs); Combination group (use of both Statins and anti-inflammatory or antibiotic drugs), and a Non-use group (taking none of the listed drugs). The mean CRP level was significantly lower in the Statin use group than the Non-use group (0.3 mg/dL, 95%CI: 0.3-0.3 and 0.4 mg/dL, 95%CI: 0.4-0.5). In multivariable regression modeling, the Statin use group had significantly lower predicted mean WBC (Beta Coeff: -0.2, p < 0.05) and CRP (Beta Coeff: -0.1, p < 0.01) values than the Non-use group. CONCLUSIONS: Treatment with statins was significantly associated with decreased WBC and CRP levels in this large population-based sample. |
Assessing the validity of the Omron HEM-907XL oscillometric blood pressure measurement device in a National Survey environment
Ostchega Y , Nwankwo T , Sorlie PD , Wolz M , Zipf G . J Clin Hypertens (Greenwich) 2010 12 (1) 22-8 Blood pressure (BP) readings taken by Omron HEM-907XL were compared with the results obtained using sphygmomanometer (HgS) in 509 individuals using 2002 Association for the Advancement of Medical Instrumentation (AAMI) criteria. With the exception of diastolic BP in youth ages 13 to 19 years (mean difference, -1.77 mm Hg; standard deviation, 8.65), the Omron device met the criteria. Agreement for hypertension (BP >or=140/90 mm Hg) was above chance (kappa=0.68) and, compared with HgS, Omron underestimated the prevalence of hypertension by 2.65%. The Omron and HgS measurements were highly correlated (r=0.94 for systolic BP and r=0.83 for diastolic BP). Both increased systolic and diastolic BP decreased device agreement (beta-coefficient=-0.10872, P<.0001; beta-coefficient=-0.25981, P<.0001, respectively). The Omron device meets AAMI criteria with the exception of diastolic BP in youth ages 13 to 19 years. However, Omron underestimated the prevalence of hypertension and device agreement decreases with increased systolic and diastolic BP. |
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