Abstract P043: National Trends in Hypertension Control 1999-2012 and Projected Impact on Incident Stroke by Age, Sex, and Race: The Cardiovascular Disease Policy Model

Background: Blood pressure (BP) control rates have improved over the decade, as have stroke rates. We determined the impact of secular BP trends on national stroke rates by age, sex, and specifically for US Blacks. Methods: We estimated national BP distributions from NHANES and quantified changes from ‘99-‘04 to ‘07-‘12 by age (35-64, 65-84 years), sex, and separately for Blacks. We used these as inputs to the Cardiovascular Disease Policy Model (CVDPM), a population-based computer simulation of CVD nationally. CVDPM data inputs include the Census, vital statistics, NHANES, national hospitalization data, and Framingham among others. CVDPM has been adapted to US Blacks (CVDPM-AA) using these sources as well as cohorts including ARIC and REGARDS. Both models are calibrated to reproduce event rates in the baseline year and outcomes of intervention studies. We projected changes in incident strokes attributable to changes in BP distribution and also modeled universal BP control (systolic BP Results: Among older US adults, the prevalence of systolic BP ≥140 mmHg decreased over the period (Table). Among younger adults, improvements in BP control were only observed in all US and Black women, not US or Black men. The projected benefit from prevented stroke attributable to improvements in BP control is substantial for all older adults and for younger women, and the magnitude is particularly striking for Blacks. Stroke reduction attributable to BP control is not observed in younger men. Universal BP control is projected to have a large impact on incident stroke reduction, at least twice the impact estimated from the secular trends in BP reduction from 1999-2012 in most groups. Conclusions: Recent improvements in BP control are projected to contribute to stroke prevention in all groups in the US, except men younger than 65 years. Additional hypertension control efforts will yield considerable additional benefits in stroke prevention.