Trends of blood pressure control in metabolic syndrome among US adults: evidence from NHANES 1999 to 2020.

BACKGROUND: Metabolic Syndrome (MetS) involves several cardiovascular risk factors, with hypertension being a critical component that significantly impacts cardiovascular outcomes. As guidelines support blood pressure control in populations with high cardiovascular risk factors, we evaluated BP control in MetS patients. METHODS: We conducted a cross-sectional analysis of probability samples of adults aged ≥ 18 years with MetS from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2020 to assess changes in BP control. MetS was identified by meeting at least three of the following criteria: (1) waist circumference ≥ 102 cm in men and ≥ 88 cm in women; (2) fasting glucose ≥ 100 mg/dl; (3) BP ≥ 130/85 mmHg; (4) triglycerides ≥ 150 mg/dl; and (5) high-density lipoprotein cholesterol (HDL-C) < 40 mg/dl in men and < 50 mg/dl in women. BP control was defined as systolic BP < 130 mmHg and diastolic BP < 80 mmHg. All analyses accounted for differences between survey years, complex sampling design, and survey weights. RESULTS: From 1999-2002 to 2015-2020, the prevalence of MetS increased from 19% to 24% (P < 0.001). Among MetS patients, the proportion of those self-reporting hypertension or taking BP medications increased from 65% in 1999-2002 to 72% in 2015-2020 (P = 0.001). Over time, both the use and quantity of antihypertensive medications increased significantly, and according to current guidelines, BP control among MetS patients has improved significantly. Similar trends were observed across subgroups stratified by gender, diabetes status, and CKD status. CONCLUSION: BP management in MetS patients showed significant improvement from 1999 to 2020, with increasing control rates despite fluctuations.