|Control of high blood pressure improving
About 50 percent of patients with hypertension have adequate control of
their blood pressure, meeting a goal of Healthy People 2010, but the
rate of hypertension in the U.S. has not decreased in recent years,
according to a study in the May 26 issue of The Journal of the American
Medical Association (JAMA).
Brent M. Egan, M.D., MUSC professor, Division of General Internal
Medicine, and colleagues examined changes in hypertension prevalence,
awareness, treatment, and control for all adults combined and for
subsets by age, race/ethnicity, and sex. These were measured across the
National Health and Nutrition Examination Survey (1988-1994 and
1999-2008) in five two-year blocks, which included 42,856 adults older
than 18 years, representing a sample of the U.S. population.
Hypertension was defined as systolic BP of at least 140 mm Hg and
diastolic BP of at least 90 mm Hg, self-reported use of
antihypertensive medications, or both.
The researchers found that the rates of hypertension increased from
23.9 percent in 1988-1994 to 28.5 percent in 1999-2000, but did not
change between 1999-2000 and 2007-2008 (29.0 percent). “… prevalent
hypertension is not decreasing toward the national goal of 16 percent
and will likely remain high unless adverse trends in population
nutrition and body mass index occur or pharmacological approaches to
hypertension prevention are adopted,” they write.
Hypertension control increased from 27.3 percent in 1988-1994 to
50.1 percent in 2007-2008, and BP among patients with
hypertension decreased from 143.0/80.4 mm Hg to 135.2/74.1 mm Hg.
“Blood pressure control improved significantly more in absolute
percentages between 1999-2000 and 2007-2008 vs. 1988-1994 and
1999-2000. Better BP control reflected improvements in awareness,
treatment, and proportion of patients who were treated and had
controlled hypertension. Hypertension control improved between
1988-1994 and 2007-2008, across age, race, and sex groups, but was
lower among individuals aged 18 to 39 years vs. 40 to 59 years and 60
years or older, and in Hispanic vs. white individuals,” the authors
“Hypertension control improved, despite adverse changes in nutrition
and body mass index and reflects increases in awareness, treatment, and
patients who were treated attaining target BP, in all individuals with
hypertension combined and all age, race, and sex subgroups. However,
demographic disparities exist. Broad-based efforts to improve
awareness, treatment, and proportion of patients treated and controlled
are important for increasing BP control in all groups. Comple-mentary
programs to raise awareness and treatment among 18 to 39 years,
Hispanic, and male groups and to increase the proportion of patients
treated and controlled among 60 years or older, black, and female
groups are important for improving hypertension control and reducing
disparities,” the researchers conclude.
Egan said he’d like to congratulate primary care clinicians across the
country. The good news is that for patients who have hypertension, the
rate has gone from 27 percent to 50 percent being under control; and,
for those taking blood pressure medications, control rates rose from 51
percent to 69 percent.
“That’s really more than most experts would have ever predicted,” he
said. “The improvement in hypertension control is really striking
in the past seven to eight years and reflects excellent work by primary
care clinicians across the country.”
That the prevalence of hypertension is not decreasing toward the
national goal of 16 percent remains a problem to be addressed.
Medication can be used as a strategy to prevent hypertension, he said,
but the best choice remains making better lifestyle choices.
“Until people start controlling their weight, eating healthy and
getting some exercise, the prevalence is not going to go down,” he
said. “If we really want it to go down, what we need to do is live
healthier lives. That’s the bottom line.”
Friday, May 28, 2010