Prevalence of hypertension and controlled hypertension - United States, 2007-2010.

Hypertension is a major risk factor for heart disease and stroke. As the first and fourth leading causes of death in the United States, heart disease and stroke occur in approximately 30% of adults aged ≥18 years in the United States. Disparities in the prevalence of hypertension among racial/ethnic groups have persisted at least since 1960, with the prevalence remaining highest among non-Hispanic black adults. Blood pressure control among those with hypertension can reduce the risk of subsequent cardiovascular diseases. Among adults with hypertension, Mexican-American persons born outside the United States, and persons without health insurance had lower rates of blood pressure control in 2005-2008. Not only do non-Hispanic black adults have higher rates of hypertension, but among those with hypertension they also have lower rates of blood pressure control than non-Hispanic white adults.

Coronary heart disease and stroke deaths - United States, 2009.

Heart disease and stroke are the first and fourth leading causes of death, respectively in the United States. In 2008, heart disease and stroke were responsible for nearly a third of all deaths in the United States (30.4%), killing more than three-quarters of a million people that year. Coronary heart disease (CHD) is the cause of more than two-thirds of all heart disease-related deaths. One of the Healthy People 2020 objectives includes reducing the rate of CHD deaths by 20% from the baseline rate of 126 deaths per 100,000 population per year, to a goal of 100.8 deaths per 100,000 (objective HDS-2). The objectives also include reducing the rate of stroke deaths by 20% over the baseline of 42.2 deaths per 100,000, to a goal of 33.8 deaths per 100,000 population. Although the rates of death from both CHD and stroke have declined continuously in recent decades and the Healthy People 2010 goals for these two objectives were met among the overall U.S. population in 2004, the death rates remain high, particularly among men and blacks.

Validity of predictive equations for 24-h urinary sodium excretion in adults aged 18-39 y.

BACKGROUND: Collecting a 24-h urine sample is recommended for monitoring the mean population sodium intake, but implementation can be difficult. OBJECTIVE: The objective was to assess the validity of published equations by using spot urinary sodium concentrations to predict 24-h sodium excretion. DESIGN: This was a cross-sectional study, conducted from June to August 2011 in metropolitan Washington, DC, of 407 adults aged 18-39 y, 48% black, who collected each urine void in a separate container for 24 h. Four timed voids (morning, afternoon, evening, and overnight) were selected from each 24-h collection. Published equations were used to predict 24-h sodium excretion with spot urine by specimen timing and race-sex subgroups. We examined mean differences with measured 24-h sodium excretion (bias) and individual differences with the use of Bland-Altman plots. RESULTS: Across equations and specimens, mean bias in predicting 24-h sodium excretion for all participants ranged from -267 to 1300 mg (Kawasaki equation). Bias was least with International Cooperative Study on Salt, Other Factors, and Blood Pressure (INTERSALT) equations with morning (-165 mg; 95% CI: -295, 36 mg), afternoon (-90 mg; -208, 28 mg), and evening (-120 mg; -230, -11 mg) specimens. With overnight specimens, mean bias was least when the Tanaka (-23 mg; 95% CI: -141, 95 mg) or Mage (-145 mg; -314, 25 mg) equations were used but was statistically significant when using the Tanaka equations among females (216 to 243 mg) and the Mage equations among races other than black (-554 to -372 mg). Significant over- and underprediction occurred across individual sodium excretion concentrations. CONCLUSIONS: Using a single spot urine, INTERSALT equations may provide the least biased information about population mean sodium intakes among young US adults. None of the equations evaluated provided unbiased estimates of individual 24-h sodium excretion.

Urinary excretion of sodium, potassium, and chloride, but not iodine, varies by timing of collection in a 24-hour calibration study.

Because of the logistic complexity, excessive respondent burden, and high cost of conducting 24-h urine collections in a national survey, alternative strategies to monitor sodium intake at the population level need to be evaluated. We conducted a calibration study to assess the ability to characterize sodium intake from timed-spot urine samples calibrated to a 24-h urine collection. In this report, we described the overall design and basic results of the study. Adults aged 18-39 y were recruited to collect urine for a 24-h period, placing each void in a separate container. Four timed-spot specimens (morning, afternoon, evening, and overnight) and the 24-h collection were analyzed for sodium, potassium, chloride, creatinine, and iodine. Of 481 eligible persons, 407 (54% female, 48% black) completed a 24-h urine collection. A subsample (n = 133) collected a second 24-h urine 4-11 d later. Mean sodium excretion was 3.54 ± 1.51 g/d for males and 3.09 ± 1.26 g/d for females. Sensitivity analysis excluding those who did not meet the expected creatinine excretion criterion showed the same results. Day-to-day variability for sodium, potassium, chloride, and iodine was observed among those collecting two 24-h urine samples (CV = 16-29% for 24-h urine samples and 21-41% for timed-spot specimens). Among all race-gender groups, overnight specimens had larger volumes (P < 0.01) and lower sodium (P < 0.01 to P = 0.26), potassium (P < 0.01), and chloride (P < 0.01) concentrations compared with other timed-spot urine samples, although the differences were not always significant. Urine creatinine and iodine concentrations did not differ by the timing of collection. The observed day-to-day and diurnal variations in sodium excretion illustrate the importance of accounting for these factors when developing calibration equations from this study.

Control of hypertension among adults--National Health and Nutrition Examination Survey, United States, 2005-2008.

Cardiovascular disease (CVD) is the leading cause of preventable death in the United States, and approximately 1 million heart attacks and 700,000 strokes occur annually. Hypertension is a major risk factor for cardiovascular disease and stroke; the unadjusted prevalence of hypertension among U.S. adults aged ≥18 years is approximately 31% (representing 68 million adults), and hypertension increases with age to approximately 70% among persons aged ≥65 years. Hypertension contributes to one out of every seven deaths in the United States, and approximately 70% of persons who have a first heart attack or stroke or who have heart failure have hypertension. In clinical trials, treatment of hypertension was associated with substantial reductions in stroke incidence (35%-40%), myocardial infarction (20%-25%), and heart failure (>50%). The estimated annual direct costs of hypertension are approximately $69.9 billion, and the estimated annual indirect costs are $23.6 billion.

Screening for lipid disorders among adults--National Health and Nutrition Examination Survey, United States, 2005-2008.

Cardiovascular disease (CVD) is the leading cause of preventable death in the United States, a major contributor to adult disability, and one of the most expensive conditions treated in U.S. hospitals. Lipid disorders (e.g., high blood cholesterol and triglycerides) increase the risk for atherosclerosis, which can lead to coronary heart disease (CHD), which accounts for a substantial proportion of cardiovascular mortality. Screening for lipid abnormalities is essential in detecting and properly managing lipid disorders early in the atherogenic process, thereby preventing the development of atherosclerotic plaques and minimizing existing plaques. Based on evidence-based studies, the United States Preventive Services Task Force (USPSTF) concluded that lipid measurement can identify asymptomatic adults who are eligible for cholesterol-lowering therapy.