Physicians' health habits are associated with lifestyle counseling for hypertensive patients.

BACKGROUND: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII) recommended lifestyle interventions, either with or without pharmacologic treatment, for all patients with high blood pressure. The objective of this study is to determine the association of physicians' personal habits with their attitudes and behaviors regarding JNC VII lifestyle modification guidelines. METHODS: One thousand primary care physicians completed DocStyles 2010, a voluntary web-based survey designed to provide insight into physician attitudes and behaviors regarding various health issues. RESULTS: The respondents' average age was 45.3 years, and 68% were male. In regards to physician behavior, 4.0% smoked at least once a week, 38.6% ate ≥5 cups of fruits and/or vegetables ≥5 days/week, and 27.4% exercised ≥5 days/week. When asked about specific types of advice offered to their hypertensive patients, physicians reported recommending that their patients eat a healthy diet (92.2%), or cut down on salt (96.1%), or attain or maintain a healthy weight (94.8%), or limit the use of alcohol (75.4%), or be physically active (94.4%). Collectively, 66.5% made all 5 lifestyle modification recommendations. Nonsmoking physicians were more likely to recommend each lifestyle intervention to their hypertensive patients. Those who exercised at least 1 day per week were more likely to recommend limiting alcohol use. CONCLUSIONS: The probability of recommending all 5 JNC VII interventions was greater for physicians who were nonsmoking and who exercised at least 1 day a week.

Further development of the temporal model of control.

The temporal model of control (Frazier, Berman, & Steward, 2001) posits that different temporal aspects of control (i.e., past, present, and future) have markedly different relations with adjustment and need to be clearly distinguished from each other. The Perceived Control over Stressful Events Scale (PCOSES; Frazier, Keenan, et al., 2011) was recently developed to assess these different aspects of control and to advance understanding of the role of perceived control in adjustment to stressful life events. The goals of the 2 studies presented here were to expand the temporal model of control by developing a new subscale of the PCOSES and to gather additional evidence regarding the temporal model. In Study 1, we developed a new future likelihood subscale and found evidence for the internal consistency, test-retest reliability, and construct validity of its scores in a sample of undergraduate students (N = 201). In Study 2, we confirmed the 4-factor structure of the PCOSES with the new future likelihood subscale using confirmatory factor analysis in another sample of undergraduates (N = 1,084). Study 2 also provided additional evidence, consistent with the temporal model, that the PCOSES subscales were differentially related to distress and other forms of adjustment (e.g., physical health) and that present control and future likelihood were associated with less event-related distress after controlling for 4 known correlates of distress (e.g., social support). Implications for counseling psychology research and practice are discussed.

Sodium consumption among hypertensive adults advised to reduce their intake: national health and nutrition examination survey, 1999-2004.

The authors estimated the prevalence of taking action to reduce intake related to actual sodium consumption among 2970 nonpregnant US adults 18 years and older with self-reported hypertension by using data from the National Health and Nutrition Examination Survey 1999-2004. Adjusted multiple linear regression assessed differences in mean sodium intake by action status. A total of 60.5% of hypertensive adults received advice to reduce sodium intake. Of this group, 83.7% took action to reduce sodium. Action to reduce sodium intake differed significantly by age, race/ethnicity, and use of an antihypertensive. The mean (±standard error) sodium intake among hypertensive adults was 3341±37 mg and differed by sex, age, race/ethnicity, education, and body mass index (P<.05), with the lowest intake among adults aged 65 years and older (2780±48 mg). Mean intake did not differ significantly by action status either overall or by subgroup except for one age category: among patients 65 years and older, mean intake was significantly lower among those who took action (2715±63 mg) than among those who did not (3401±206 mg; P=.0124). Regardless of action, mean intake was well above 1999-2004 recommendations for daily sodium intake and about twice as high as the current recommendation for hypertensive adults (1500 mg).

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.

Public health options for improving cardiovascular health among older Americans.

Life expectancy at birth has increased from 74 years in 1980 to 78 years in 2006. Older adults (aged 65 years and older) are living longer with cardiovascular conditions, which are leading causes of death and disability and thus an important public health concern. We describe several major issues, including the impact of comorbidities, the role of cognitive health, prevention and intervention approaches, and opportunities for collaboration to strengthen the public health system. Prevention can be effective at any age, including for older adults. Public health models focusing on policy, systems, and environmental change approaches have the goal of providing social and physical environments and promoting healthy choices.

National surveillance definitions for hypertension prevalence and control among adults.

BACKGROUND: Clear and consistent definitions of hypertension and hypertension control are crucial to guide diagnosis, treatment, and surveillance. A variety of surveillance definitions are in frequent use, resulting in variation of reported hypertension prevalence and control, even when based on the same data set. METHODS AND RESULTS: To assess the variety of published surveillance definitions and rates, we performed a literature search for studies and reports that used National Health and Nutrition Examination Surveys (NHANES) data from at least as recent as the 2003 to 2004 survey cycle. We identified 19 studies that used various criteria for defining hypertension and hypertension control, as well as different parameters for age adjustment and inclusion of subpopulations. This resulted in variation of reported age-standardized hypertension prevalence from 28.9% to 32.1% and hypertension control from 35.1% to 64%. We then assessed the effects of varying the definitions of hypertension and hypertension control, parameters for age adjustment, and inclusion of subpopulations on NHANES data from both 2007 to 2008 (n=5645) and 2005 to 2008 (n=10 365). We propose standard surveillance definitions and age-adjustment parameters for hypertension and hypertension control. By using our recommended approach with NHANES 2007 to 2008 data, the age-standardized prevalence of hypertension in the United States was 29.8% (SE, 0.62%) and the rate of hypertension control was 45.8% (SE, 4.03%). CONCLUSIONS: Surveillance definitions of hypertension and hypertension control vary in the literature. We present standard definitions of hypertension prevalence and control among adults and standard parameters for age-adjustment and population composition that will enable meaningful population comparisons and monitoring of trends.

Regular use of a home blood pressure monitor by hypertensive adults--HealthStyles, 2005 and 2008.

The authors analyzed HealthStyles surveys 2005 and 2008 combined to assess the prevalence of regular home blood pressure monitor (HBPM) use among hypertensive adults. All data were self-reported. The authors calculated odds ratios (ORs) of regular HBPM use and relative percent change (RPC) in the use of HBPM between the 2 survey years. There were 3739 (32.6%) hypertensives in the 2 survey years combined. Based on the self-reported data, the proportion of hypertensives who regularly used an HBPM was 43.2%. Male sex, age, race/ethnicity, household income, and education were all associated with differences in the prevalence of regular HBPM use. Patients 65 years and older (OR, 2.38; 95% confidence interval [CI], 1.49-3.81) were significantly more likely to be regular HBPM users than those 18 to 34 years. Non-Hispanic blacks were significantly less likely (OR, 0.69; 95% CI, 0.55-0.86) to be regular HBPM users than non-Hispanic whites. From 2005 to 2008, the RPC in regular HBPM use was 14.2% (from 40.1% to 45.8%); the largest RPCs were for the 3 youngest age groups, men, non-Hispanic blacks, and those with a household income of $40,000 to 59,900. Because HBPM has been demonstrated to aid in hypertension control, health care professionals should promote its use especially among hypertensives who are younger, non-Hispanic blacks, Hispanics, or with a lower income.

Stroke in South Asia: a systematic review of epidemiologic literature from 1980 to 2010.

BACKGROUND: Globally 15 million people have an acute stroke every year and one third of them die secondary to stroke events. Most research on stroke prevention and treatment is done in developed countries, yet more than 85% of strokes occur in developing countries. In particular, stroke remains an underrecognized cause of death and disability in South Asia. METHODS: We conducted a systematic review to identify reliable and comparable epidemiological evidence on stroke in South Asia from 1980 to 2010. Publications were screened for eligibility to identify only population-based stroke studies. RESULTS: Of the 71 studies retrieved, only 6 studies from South Asia gave us acceptable estimates of the burden of stroke. Population-based studies from South Asia have stroke prevalence in the range of 45-471 per 100,000. The age-adjusted incidence rate varied from approximately 145 per 100,000 to 262 per 100,000. Rural parts of South Asia have a lower stroke prevalence compared with urban areas. CONCLUSIONS: Our review highlights the paucity of research data in South Asia. This must be addressed in order to accurately determine the burden of stroke in South Asia, so that specific policy recommendations can be formulated to combat the stroke epidemic in this region.

Association of sleep duration and hypertension among US adults varies by age and sex.

BACKGROUND: While short sleep duration has been related to hypertension, the impact of age and sex on this association is less well known. We examined the association between hours of sleep and hypertension prevalence among US adults by age and sex. METHODS: The study was conducted using data from the 2007-2009 National Health Interview Surveys (NHISs). The association between self-reported hours of sleep and prevalence of hypertension was assessed after stratifying by age and sex. RESULTS: Among 71,455 participants, age-standardized hypertension prevalence rates (%) were 32.4, 25.5, 22.2, 23.2, 25.5, and 32.5 among adults reporting sleep of <6, 6, 7, 8, 9, and ≥10 h/day, respectively (P < 0.001). There was a "U"-shaped association of hours of sleep and hypertension prevalence among all age and sex subgroups. Logistic regression models, using 8 h sleep/day as the referent, showed a greater likelihood of hypertension among those who slept <7 or ≥10 h/day after adjusting for sociodemographic, behavior, and health characteristics. Further stratifying by age and sex, while adjusting for all other characteristics, revealed that among adults less than 45 years, short (<6 h for men and <8 h for women) and long (≥10 h for men) sleep were associated with higher likelihood of hypertension. For other age/sex groups, short sleep (<6 h) was associated with higher likelihood of hypertension among middle-aged men and older women, as was long sleep (≥10 h) among middle-aged women. CONCLUSIONS: This national sample study suggests that the association between hours of sleep and hypertension varies by age and sex.

Risk of cardiovascular mortality in relation to optimal low-density lipoprotein cholesterol combined with hypertriglyceridemia: is there a difference by gender?

PURPOSE: The objectives of the present study were to determine whether an optimal low-density lipoprotein cholesterol (LDL-C) combined with hypertriglyceridemia was associated with cardiovascular disease (CVD) mortality and whether these associations differ by gender. METHODS: A cohort of 2903 U.S. adults aged ≥45 years (men) and ≥55 years (women) at baseline (1988-1994) was followed through December 2006 for CVD mortality. Baseline data were collected through the Third National Health and Nutrition Examination Survey (NHANES III). The definitions of high LDL-C and high triglycerides (TG) (hypertriglyceridemia) levels were based on the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) guidelines. Cox proportional hazard models were used to estimate the hazard ratio (HR) with 95% confidence interval (CI) of death. RESULTS: After adjusting for age, race/ethnicity, and traditional CVD risk factors, the risk of CVD death was approximately two times as high among women with optimal LDL-C/hypertriglyceridemia (2.42, 95% CI = 1.35-4.33) compared to women with optimal LDL-C/normal TG. In contrast, no significant difference was found among men on this comparison. CONCLUSIONS: Judging from this study, hypertriglyceridemia is associated with an increased risk of CVD mortality in women but not in men. The association is independent of abnormal LDL-C effect.

Racial/ethnic and socioeconomic disparities in health-related quality of life among people with coronary heart disease, 2007.

INTRODUCTION: Health-related quality of life (HRQOL) refers to a person's or group's perceived physical and mental health over time. Coronary heart disease (CHD) affects HRQOL and likely varies among groups. This study examined disparities in HRQOL among adults with self-reported CHD. METHODS: We examined disparities in HRQOL by using the unhealthy days measurements among adults who self-reported CHD in the 2007 Behavioral Risk Factor Surveillance System state-based telephone survey. CHD was based on self-reported medical history of heart attack, angina, or coronary heart disease. We assessed differences in fair/poor health status, 14 or more physically unhealthy days, 14 or more mentally unhealthy days, 14 or more total unhealthy days (total of physically and mentally unhealthy days), and 14 or more activity-limited days. Multivariate logistic regression models included age, race/ethnicity, sex, education, annual household income, household size, and health insurance coverage. RESULTS: Of the population surveyed, 35,378 (6.1%) self-reported CHD. Compared with non-Hispanic whites, Native Americans were more likely to report fair/poor health status (adjusted odds ratio [AOR], 1.7), 14 or more total unhealthy days (AOR, 1.6), 14 or more physically unhealthy days (AOR, 1.7), and 14 or more activity-limited days (AOR, 1.9). Hispanics were more likely than non-Hispanic whites to report fair/poor health status (AOR, 1.5) and less likely to report 14 or more activity-limited days (AOR, 0.5), and Asians were less likely to report 14 or more activity-limited days (AOR, 0.2). Non-Hispanic blacks did not differ in unhealthy days measurements from non-Hispanic whites. The proportion reporting 14 or more total unhealthy days increased with increasing age, was higher among women than men, and was lower with increasing levels of education and income. CONCLUSION: There are sex, racial/ethnic, and socioeconomic disparities in HRQOL among people with CHD. Tailoring interventions to people who have both with CHD and poor HRQOL may assist in the overall management of CHD.

Awareness of heart attack symptoms among US adults in 2007, and changes in awareness from 2001 to 2007.

OBJECTIVE: Timely access to emergency care, prompt receipt of advanced treatment and survival from heart attack is dependent on both the early recognition of heart attack symptoms, by both victims and bystanders, and by immediately calling the emergency services. The objective of this study is to measure the awareness of heart attack symptoms and the emergency response among US adults. METHOD: We analyzed data from the Behavioral Risk Factor Surveillance System's module on heart attack and stroke, which was conducted in 17 states/territories in 2001 and 12 states/territories in 2007. The module included five questions related to heart attack symptoms, one decoy question and one question regarding the first action to take if someone is having a heart attack. Age-adjusted prevalence of awareness was estimated, and odds ratios were calculated. Differences between 2001 and 2007 were assessed for five states that used the module in both years. RESULTS: In 2007, among 76,864 adults, awareness of individual heart attack symptoms ranged from 49% (pain in jaw, neck or back) to 92% (chest pain). Although 97% of adults recognized at least one symptom, only 10.7% recognized all five symptoms, knew that 'sudden trouble seeing in one or both eyes' was not a symptom of heart attack and recognized the need to call the emergency services. This estimate varied significantly by age, sex, race/ethnicity and level of education. The estimate was significantly higher for women (12.2%) than men (7.7%), White (11.6%) than Black (5.7%) or Hispanic people (4.5%), those with a higher level of education (13.5%) than lower educational level (4.5%) and for those with coronary heart disease (16.2%) than without the disease (9.5%). Comparison of awareness between 2001 (the referent) and 2007, in five states, revealed that awareness of all symptoms and calling the emergency services, were 9.7 and 10.3% for 2001 and 2007, respectively (p < 0.01). Compared to 2001, the odds ratio of awareness in 2007 was 1.08 (95% CI: 0.99-1.19) after controlling for socioeconomic and clinical characteristics. CONCLUSION: Awareness of all heart attack symptoms among adults in 12 states was low and little improvement was observed between 2001 and 2007. Accordingly, both clinicians and public health officials should seek ways in order to increase public awareness of the symptoms of heart attack. Special efforts should be focused on men, Black and Hispanic people and those with only modest levels of education.

Perceived past, present, and future control and adjustment to stressful life events.

Perceived control is a central construct in psychology and is key to understanding individual differences in poststress outcomes (Frazier, Berman, & Steward, 2001). The goals of the current studies (using 4 samples of undergraduate students, total N = 1,421) were to examine the relations between different aspects of perceived control and poststress outcomes and to differentiate perceived control over specific events from related constructs (i.e., general control beliefs, coping strategies). To accomplish these goals, we first developed a new measure of perceived past, present, and future control over stressful life events. The data supported the content validity, factor structure, internal consistency and test-retest reliability, and convergent and discriminant validity of the new measure. Consistent with the temporal model of control (Frazier et al., 2001), these 3 forms of control had very different relations with adjustment. Present control was consistently related to lower distress levels in cross-sectional, longitudinal, and prospective analyses. Present control also predicted outcomes beyond the effects of general control beliefs and coping strategies. Past and future control had nonsignificant or positive relations with distress, although future control was associated with better outcomes (i.e., course grades) when the stressor was controllable. Thus, our measure can be used to assess the relations between perceived past, present, and future control and outcomes across a range of stressors. Because the relations between these 3 forms of control and outcomes differ markedly, measures that combine these aspects of control hinder the understanding of the important role of perceived control in adjustment to stress.

Fruit/vegetable intake and physical activity among adults with high cholesterol.

OBJECTIVES: To determine whether hypercholesterolemic adults followed healthy eating and appropriate physical activity. METHODS: Using the 2007 Behavioral Risk Factor Surveillance System, we measured ≥5 servings of fruits and vegetables/day and Healthy People 2010 recommended physical activity. RESULTS: Of 363,667 adults ≥18 years, 37.3% had hypercholesterolemia. The percentages of healthy eating and physical activity were lower among those with hypercholesterolemia than among those without (23.8% vs 27.9% for healthy eating [P< 0.001], 43.1% vs 51.7% for physical activity [P<0.001]). CONCLUSION: Hypercholesterolemic adults are less likely to practice healthy eating and to engage in physical activity than are those without hypercholesterolemia.

Actions taken to reduce sodium intake among adults with self-reported hypertension: HealthStyles survey, 2005 and 2008.

Consuming high amounts of dietary sodium is associated with hypertension. The authors analyzed the HealthStyles 2005 and 2008 survey for behaviors to lower blood pressure related to dietary sodium, including the reduction of sodium intake and reading food labels for sodium content among hypertensives. All estimates were based on self-reported data. The relative percent change (RPC) in the prevalence of these behaviors between 2005 and 2008 was assessed. During the 3-year period, there were increases in the prevalence of reducing dietary sodium (RPC=17.2%, 56.6% in 2008 vs 48.3% in 2005; P<.05) and reading food labels for sodium content (RPC=7.9%, 53.0% vs 49.1%; P<.05). In 2005, the proportion of hypertensive adults who reported reducing dietary sodium was higher for persons 65 years and older, for blacks, for those with income <$25,000, and for those with more than a high school education compared with those in their comparison groups. In 2008, those aged 65 years and older had the highest percentage, while Hispanics and blacks had essentially the same percentage for reducing sodium. Based on 2005 and 2008 HealthStyles surveys, about half of hypertensive patients reported reducing their intake of sodium and reading food labels for salt. Health care providers should emphasize the importance of knowing the daily recommended limit for dietary sodium to help adults lower this intake.

Prevalence of self-reported hypertension, advice received from health care professionals, and actions taken to reduce blood pressure among US adults--HealthStyles, 2008.

Lifestyle changes, such as changes in diet and exercise, are recommended to lower blood pressure (BP) in adults. Using data from the 2008 HealthStyles survey, the authors estimated the prevalence of self-reported hypertension, advice received from health professionals, and actions taken to reduce BP. Among 5399 respondents, 25.8% had hypertension and 79.8% of these were currently taking antihypertensive medications. Overall, 21.0% to 24.4% reported receiving advice to adopt specific behavior changes, with younger adults and women having a lower prevalence of receiving advice. Blacks had the highest prevalence among the racial/ethnic groups of receiving advice, and household income was associated with receiving advice. More than half of respondents took action following the receipt of advice. Women were more likely than men to follow advice to go on a diet. Although many patients were following advice from their health professional and making lifestyle changes to decrease BP, the proportion of patients making changes remains suboptimal. Receiving advice from health professionals and following recommendations to reduce or control high BP are essential to hypertension management. Counseling on lifestyle modification should continue to be an integral component of visits to health professionals.

Prevalence of coronary heart disease risk factors and screening for high cholesterol levels among young adults, United States, 1999-2006.

PURPOSE: Previous studies have reported low rates of screening for high cholesterol levels among young adults in the United States. Although recommendations for screening young adults without risk factors for coronary heart disease (CHD) differ, all guidelines recommend screening adults with CHD, CHD equivalents, or 1 or more CHD risk factors. This study examined national prevalence of CHD risk factors and compliance with the cholesterol screening guidelines among young adults. METHODS: National estimates were obtained using results for 2,587 young adults (men aged 20 to 35 years; women aged 20 to 45 years) from the 1999-2006 National Health and Nutrition Examination Surveys. We defined high low-density lipoprotein cholesterol (LDL-C) as levels higher than the goal specific for each CHD risk category outlined in the National Cholesterol Education Program Adult Treatment Panel III guidelines. RESULTS: About 59% of young adults had CHD or CHD equivalents, or 1 or more of the following CHD risk factors: family history of early CHD, smoking, hypertension, or obesity. In our study, the overall screening rate in this population was less than 50%. Moreover, no significant difference in screening rates between young adults with no risk factors and their counterparts with 1 or more risk factors was found even after adjustment for sociodemographic and health care factors. Approximately 65% of young adults with CHD or CHD equivalents, 26% of young adults with 2 or more risk factors, 12% of young adults with 1 risk factor, and 7% with no risk factor had a high level of LDL-C. CONCLUSIONS: CHD risk factors are common in young adults but do not appear to alter screening rates. Improvement of risk assessment and management for cardiovascular disease among young adults is warranted.