we analyzed the sample of older adults ( 65 years of age or older , n = 3,810 ) participating in nhanes 19992004 , a continuing statistical survey of the noninstitutionalized civilian u.s . all study participants have blood pressure measurements taken , whereas those in the nhanes morning subset ( n = 1,556 ) also have measurements taken of fasting plasma glucose and lipids . in accordance with american diabetes association criteria for epidemiological studies ( 20 ) , study participants were considered to have diabetes if they met one or more of the following conditions : their fasting plasma glucose level was 126 mg / dl , or they reported being told by a physician that they had diabetes , or they were taking glucose - lowering medications . a person was considered  aware if he / she responded positively to the question ,  have you ever been told by a doctor that you have diabetes or sugar diabetes ?  study participants who reported taking insulin or oral hypoglycemic agents were classified as  treated . a treated person was considered  controlled  if hba1c was less than 7% . hypertension was defined in accordance with the seventh report of the joint national committee on prevention , detection , evaluation , and treatment of high blood pressure ( jnc 7 ) ( 7 ) . a person was deemed to have hypertension if the nhanes examination indicated that , based on the average of three measurements , the systolic blood pressure ( sbp ) was 140 mm hg , or the diastolic blood pressure ( dbp ) was 90 mm hg , or if he / she reported current use of antihypertensive medication . consequently , a person who may have been informed that he / she had hypertension , but who was not on medication and who tested normotensive on the day of the examination was not classified as a prevalent case of hypertension . a person with hypertension according to the jnc 7 definition was considered  aware  if he / she gave a positive response to the question ,  have you ever been told by a doctor or other health professional that you had hypertension , also called high blood pressure ?  a person with hypertension was classified as  treated  if he / she reported taking antihypertensive medication at the time of the survey . a treated person was considered  controlled  if his / her average sbp was < 140 mm hg and average dbp was < 90 mm hg . study participants were classified as having dyslipidemia if their low - density lipoprotein ( ldl ) cholesterol exceeded the appropriate risk - based threshold established by the national cholesterol education panel ( ncep ) adult treatment panel iii ( atp iii ) ( 4 ) or if they reported taking an antihyperlipidemic drug at the time of the examination . similar to hypertension , this definition excludes persons who report having previously been told that they had high cholesterol but who test negative in nhanes and are not on medication . a person with dyslipidemia according to the atp iii definition was considered  aware  if he / she gave a positive response to the question ,  have you ever been told by a doctor or other health professional that your blood cholesterol level was high ?  those who reported taking prescribed medicine to lower their blood cholesterol were considered  treated . controlled  if his / her ldl was lower than the appropriate ncep - atp iii goal . we applied survey weights to the nhanes 19992004 data to derive population estimates of the prevalence of diabetes , hypertension , and dyslipidemia , as well as awareness , treatment , and control rates of these conditions among persons aged 65 or older . calculations were performed using sas version 9.1 ( sas institute inc . , cary , nc , 2004 ) , and standard errors and p values computed using the procedure surveyfreq , which takes into account the effect on estimator variance attributable to the complex nhanes multistage stratified cluster sample design . to determine independent risk factors , multivariate logistic regression models were estimated incorporating covariates for sex , age , usual place of care , doctor visits in past year , household income , living with spouse / partner , and education level . we analyzed the sample of older adults ( 65 years of age or older , n = 3,810 ) participating in nhanes 19992004 , a continuing statistical survey of the noninstitutionalized civilian u.s . all study participants have blood pressure measurements taken , whereas those in the nhanes morning subset ( n = 1,556 ) also have measurements taken of fasting plasma glucose and lipids . in accordance with american diabetes association criteria for epidemiological studies ( 20 ) , study participants were considered to have diabetes if they met one or more of the following conditions : their fasting plasma glucose level was 126 mg / dl , or they reported being told by a physician that they had diabetes , or they were taking glucose - lowering medications . a person was considered if he / she responded positively to the question ,  have you ever been told by a doctor that you have diabetes or sugar diabetes ?  study participants who reported taking insulin or oral hypoglycemic agents were classified as  treated . a treated person was considered  controlled  if hba1c was less than 7% . hypertension was defined in accordance with the seventh report of the joint national committee on prevention , detection , evaluation , and treatment of high blood pressure ( jnc 7 ) ( 7 ) . a person was deemed to have hypertension if the nhanes examination indicated that , based on the average of three measurements , the systolic blood pressure ( sbp ) was 140 mm hg , or the diastolic blood pressure ( dbp ) was 90 mm hg , or if he / she reported current use of antihypertensive medication . consequently , a person who may have been informed that he / she had hypertension , but who was not on medication and who tested normotensive on the day of the examination was not classified as a prevalent case of hypertension . if he / she gave a positive response to the question ,  have you ever been told by a doctor or other health professional that you had hypertension , also called high blood pressure ?  a person with hypertension was classified as  treated  if he / she reported taking antihypertensive medication at the time of the survey . a treated person was considered  controlled  if his / her average sbp was < 140 mm hg and average dbp was < 90 mm hg . study participants were classified as having dyslipidemia if their low - density lipoprotein ( ldl ) cholesterol exceeded the appropriate risk - based threshold established by the national cholesterol education panel ( ncep ) adult treatment panel iii ( atp iii ) ( 4 ) or if they reported taking an antihyperlipidemic drug at the time of the examination . similar to hypertension , this definition excludes persons who report having previously been told that they had high cholesterol but who test negative in nhanes and are not on medication if he / she gave a positive response to the question ,  have you ever been told by a doctor or other health professional that your blood cholesterol level was high ? those who reported taking prescribed medicine to lower their blood cholesterol were considered  treated . controlled  if his / her ldl was lower than the appropriate ncep - atp iii goal . we applied survey weights to the nhanes 19992004 data to derive population estimates of the prevalence of diabetes , hypertension , and dyslipidemia , as well as awareness , treatment , and control rates of these conditions among persons aged 65 or older . calculations were performed using sas version 9.1 ( sas institute inc . , cary , nc , 2004 ) , and standard errors and p values computed using the procedure surveyfreq , which takes into account the effect on estimator variance attributable to the complex nhanes multistage stratified cluster sample design . to determine independent risk factors , multivariate logistic regression models were estimated incorporating covariates for sex , age , usual place of care , doctor visits in past year , household income , living with spouse / partner , and education level . table 1 shows the characteristics of adults aged 65 and older in the united states . based on nhanes 19992004 , 55.2% are 6574 years old , more than half of all elders are married or living with a partner , and virtually all older adults are insured . adults 65 years of age and older , national health and nutrition examination survey 19992004 the overall prevalence of hypertension ( table 2 ) among older adults is 70.8% , with prevalence increasing as age increases . women have a significantly higher prevalence of hypertension than men ( 76.6% vs 63.0% ) and a significantly lower rate of control on treatment ( 42.9% vs 57.9% ) . at 54.0% , blood pressure control is higher among the youngest old ( age 6574 ) compared with 41.7% and 44.6% in the two older age groups ( ages 7584 , 85 ) , respectively . overall , 42% of older adults have uncontrolled isolated systolic hypertension ( sbp 140 mm hg and dbp < 90 mm hg [ data not shown ] ) . women have significantly higher levels than men of isolated sbp 140 mm hg and < 160 mm hg ( 28.6% vs 22.1% , p < .0002 ) and of isolated sbp of 160 mm hg or greater ( 21.0% vs 10.1% , p < .0001 ) . isolated systolic hypertension accounts for 88.4% of undiagnosed hypertension among older adults . hypertension , dyslipidemia , and diabetes prevalence , awareness , treatment , and control among u.s . adults 65 years of age and older , national health and nutrition examination survey 19992004 notes : p  .05 difference between male and female , or between the age group and age 6574 . p  .01 difference between male and female , or between the age group and age 6574 . p  .001 difference between male and female , or between the age group and age 6574 . men are significantly less likely to be aware of their condition than women ( 59.1% vs 71.1% ) , although both genders are equally likely to be treated ( 40.9% vs 45.1% ) . the oldest old have a significantly lower prevalence , are less aware , and have a lower treatment rate for dyslipidemia than the youngest old . two thirds of all older adults medically treated for dyslipidemia reach their ldl cholesterol goal . diabetes ( table 2 ) affects 21.2% of adults 65 years of age and older . the awareness rate for diabetes ( 71.4% ) is driven by a significantly higher awareness among women than among men ( 78.5% vs 63.6% ) . half of all prevalent diabetes cases are treated pharmacologically , and only half of all treated cases reach hba1c goal attainment of < 7% . tables 3 , 4 , and 5 present the results of estimating separate logistic regression models for the rates of awareness , pharmacologic treatment , and control of the three conditions , adjusting for the effects of age , sex , education , number of doctor visits , living arrangement , having a usual health care provider and annual household income . logistic regression models of predictors of awareness , treatment , and control of hypertension among u.s . adults 65 years of age and older , national health and nutrition examination survey 19992004 notes : or = odds ratio ; ci = confidence interval . logistic regression models of predictors of awareness , treatment , and control of dyslipidemia among u.s . adults aged 65 and older , national health and nutrition examination survey 19992004 notes : or = odds ratio ; ci = confidence interval . logistic regression models of predictors of awareness , treatment , and control of diabetes among u.s . adults aged 65 and older , national health and nutrition examination survey 19992004 notes : or = odds ratio ; ci = confidence interval . for elders with hypertension , higher age is associated with lower rates of awareness ( odds ratio [ or ] = 0.71 [ age 7584 ] and 0.54 [ age 85 ] vs age 6574 ) , treatment ( or = 0.70 [ age 7584 ] and 0.60 [ age 85 ] vs age 6574 ) , and control ( or = 0.59 [ age 7584 ] vs age 6574 ) . among those with dyslipidemia , the oldest ( age 85 ) have significantly lower rates of awareness and treatment ( or = 0.29 and 0.38 vs age 6574 , respectively ) . although there are no significant differences between the sexes in awareness or treatment for hypertension , women on treatment are only half as likely as men to have their blood pressure controlled ( or = 0.51 ) . women are more likely than men to be aware and treated for dyslipidemia ( or = 2.60 and 1.56 , respectively ) and more likely to be aware of their diabetes ( or = 3.14 ) . there are no significant associations between education ( high school or more ) and awareness , treatment , or control of hypertension and diabetes , however , education is positively associated with awareness ( or = 1.39 ) and treatment ( or = 1.62 ) of dyslipidemia . the number of doctor visits in the past year is positively and strongly associated with awareness and treatment of all three conditions . living arrangement ( married / living with partner ) is not associated with awareness , treatment , or control of any of the conditions . elders who have a usual health care provider are far more likely than those who do not have a usual provider to be aware ( or = 2.87 ) and treated ( or = 5.10 ) for their hypertension . elders with low annual household income ( less than $ 15,000 in 2002 dollars ) are much less likely than those with income more than $ 45,000 to be aware or controlled on treatment for their dyslipidemia ( or = 0.36 and 0.39 , respectively ) . those in the middle - income range of $ 15,000$45,000 are less likely than persons with household income more than $ 45,000 to be aware of their diabetes ( or = 0.36 ) . tables 3 , 4 , and 5 present the results of estimating separate logistic regression models for the rates of awareness , pharmacologic treatment , and control of the three conditions , adjusting for the effects of age , sex , education , number of doctor visits , living arrangement , having a usual health care provider and annual household income . logistic regression models of predictors of awareness , treatment , and control of hypertension among u.s . adults 65 years of age and older , national health and nutrition examination survey 19992004 notes : or = odds ratio ; ci = confidence interval . logistic regression models of predictors of awareness , treatment , and control of dyslipidemia among u.s . adults aged 65 and older , national health and nutrition examination survey 19992004 notes : or = odds ratio ; ci = confidence interval . logistic regression models of predictors of awareness , treatment , and control of diabetes among u.s . adults aged 65 and older , national health and nutrition examination survey 19992004 notes : or = odds ratio ; ci = confidence interval . for elders with hypertension , higher age is associated with lower rates of awareness ( odds ratio [ or ] = 0.71 [ age 7584 ] and 0.54 [ age 85 ] vs age 6574 ) , treatment ( or = 0.70 [ age 7584 ] and 0.60 [ age 85 ] vs age 6574 ) , and control ( or = 0.59 [ age 7584 ] vs age 6574 ) . among those with dyslipidemia , the oldest ( age 85 ) have significantly lower rates of awareness and treatment ( or = 0.29 and 0.38 vs age 6574 , respectively ) . although there are no significant differences between the sexes in awareness or treatment for hypertension , women on treatment are only half as likely as men to have their blood pressure controlled ( or = 0.51 ) . women are more likely than men to be aware and treated for dyslipidemia ( or = 2.60 and 1.56 , respectively ) and more likely to be aware of their diabetes ( or = 3.14 ) . there are no significant associations between education ( high school or more ) and awareness , treatment , or control of hypertension and diabetes , however , education is positively associated with awareness ( or = 1.39 ) and treatment ( or = 1.62 ) of dyslipidemia . the number of doctor visits in the past year is positively and strongly associated with awareness and treatment of all three conditions . living arrangement ( married / living with partner ) is not associated with awareness , treatment , or control of any of the conditions . elders who have a usual health care provider are far more likely than those who do not have a usual provider to be aware ( or = 2.87 ) and treated ( or = 5.10 ) for their hypertension . elders with low annual household income ( less than $ 15,000 in 2002 dollars ) are much less likely than those with income more than $ 45,000 to be aware or controlled on treatment for their dyslipidemia ( or = 0.36 and 0.39 , respectively ) . those in the middle - income range of $ 15,000$45,000 are less likely than persons with household income more than $ 45,000 to be aware of their diabetes ( or = 0.36 ) . using the combined nhanes 19992004 data , these analyses provide up - to - date estimates of prevalence , awareness , treatment , and control of hypertension , dyslipidemia , and diabetes among adults aged 65 and older in the united states . our results are consistent with previous studies of prevalence of these three cardiovascular risk factors in older adults ( 810,16,17 ) ; expand the body of knowledge regarding awareness , treatment , and control rates ; and identify gender disparities among the rates . we found that older women are more likely than older men to have hypertension , equally likely to be aware and treated , but less likely to have their blood pressure controlled on pharmacotherapy . this finding is consistent with recent studies showing a positive trend of increasing blood pressure control among older adults ( age 60 ) in the nhanes study population ( 18,21 ) . the improvement in control may be due , in part , to physician education and changing practice patterns based on the jnc 7 guidelines ( 7 ) . notwithstanding this success , in the present study , women are only half as likely as men ( after adjusting for covariates ) to attain blood pressure goal . a similar finding for women ( age 20 ) was reported in a previous nhanes 19992002 study of racial disparities in hypertension , after adjusting for race ( 22 ) , suggesting that additional blood pressure control programs specifically targeted toward women are warranted . the paradigm shift of the jnc emphasizing the importance of diagnosing and treating systolic hypertension among older adults ( 23,24 ) further merits the need for such gender - specific programs . we found the prevalence of dyslipidemia to be similar by gender , with women more likely to be aware and treated . although overall treatment is only 43% , there has been a suggestive upward trend of pharmacological treatment for dyslipidemia among older adults ( age 60 ) , based on estimates from the nhanes data ( 16 ) . this trend may be attributed to some degree , to increasing adoption of the ncep guidelines ( 4 ) . control rates for dyslipidemia in this study are similar by gender and by age groups . our study found that women with diabetes are more likely than men to be aware of their condition and that only 50% of patients on pharmacotherapy are controlled ( hba1c < 7% ) . other studies in various clinical settings have documented poor diabetes control among the elderly adults ( 25,26 ) . this study provides newer evidence that confirms the need for improved quality of care . in our study , continued physician efforts to improve treatment rates and successfully treat patients to goal are needed . although our study shows that increasing numbers of doctor visits are associated with awareness and treatment for all three conditions , and with goal attainment for dyslipidemia , the interpretation of this finding is ambiguous . it may be that more frequent visits provide added opportunity for physicians to detect and treat undiagnosed disease , or the causality may be reversed , and those who already are aware and/or treated make more visits for the purpose of refilling prescriptions or monitoring treatment effectiveness . an important national public health effort to reduce cvd risk factor burden through the healthy people 2010 has had ongoing successes ( 16,27 ) , and knowledge of our study 's findings on gender differences in awareness and control may be useful to clinicians in the effort to improve outcomes . the strengths of this study include its population - based sampling frame and the availability of clinical measurements to determine undiagnosed and diagnosed disease prevalence and to determine goal attainment . additionally , using 6 years of nhanes data provides a large sample and precise estimates of conditions affecting older adults . to our knowledge , this is the first study to use nhanes 19992004 to report on the prevalence and management of cvd risk factors among adults 65 years and older a limitation in our study is that physician - specific variables , such as practitioner age , group practice size and setting ( eg , university medical center ) , and practice patterns are not available in nhanes . we used a blood pressure goal of < 140/90 mm hg for adults with hypertension with and without diabetes , a method that has been applied in other studies ( 8,9 ) . the current blood pressure goal for adults with hypertension and with diabetes is < 130/80 mm hg ( 7 ) . applying this threshold to adults with hypertension and with diabetes would result in a lower estimate of blood pressure control ( 7,9 ) . women with hypertension are disproportionately affected by higher prevalence and lower control rates than men . women with dyslipidemia or diabetes are more likely than men to be aware of their condition . for all three conditions , improvements in treatment and control rates are needed . in light of the expected growth in this population ,