Poor knowledge of high blood pressure more problematic than medication costs

CHARLESTON, SC -- Limited awareness of high blood pressure is more of a barrier to blood pressure control than the cost of medications in Americans more than 50 years old, according to an article in the March 24 issue of The Archives of Internal Medicine.

Two of the three authors of the paper are MUC faculty members. They are Brent M. Egan, M.D., professor of medicine and pharmacology, and Daniel T. Lackland, Dr. P.H., professor of biometry and epidemiology.

According to background information in the article the prevalence of hypertension and related complications, including congestive heart
failure, coronary heart disease, stroke and end-stage renal disease increases sharply as people age, whereas blood pressure control declines with age in most demographic groups. Previous studies show that although use of medications can effectively lower high blood pressure to acceptable levels, many older Americans fail to take these medications.

Egan, Lackland and Neal E. Cutler of Widener University conducted a telephone survey to investigate the knowledge, attitudes and health beliefs of individuals as they relate to blood pressure control and awareness among a national sample of 1,503 adults 50 years old and older. The researchers found that among those surveyed, 94 percent had at least one blood pressure measurement during the past year, but 46 percent did not know their blood pressure. Only 27 percent acknowledged having current high blood pressure, although 37 percent reported taking antihypertensive medications.

The researchers report that systolic hypertension (having a high top blood pressure number) was probably under-recognized, since 30 percent of respondents who reported a value of 140 millimeters of mercury (mm/hg) or higher indicated that they did not have high blood pressure.

Among those who acknowledged having high blood pressure, 80 percent reported taking medications "precisely as prescribed." Of the approximately 20 percent of patients with high blood pressure no longer taking medication, or taking fewer medications than prescribed, cost was the major contributing factor in approximately 1 in 5 or roughly four percent of the total.

The researchers also found that 60 percent of patients receiving treatment indicated that medications alone do not control their high
blood pressure. Most survey respondents (more than 90 percent) said that lifestyle changes lower blood pressure. Seventy-five percent of respondents indicated they engaged in a lifestyle change and 61 percent reported that it lowered their blood pressure. When asked what information about high blood pressure was most important, 34 percent said alternative therapies and 28 percent reported prevention strategies.

The researchers conclude: "In summary, this survey suggests that limited awareness of systolic hypertension is a greater barrier to
control than cost of medications in Americans 50 years or older. Although most older Americans who acknowledge having high blood pressure take medications, many prefer to integrate traditional, complementary, and alternative strategies."

Editorial: No Surprises in Blood Pressure Awareness Study Findings
In an accompanying editorial, Marvin Moser, M.D., of Yale University School of Medicine, New Haven, CT, writes, "Although almost 40 percent of survey respondents [in the Egan et al study] reported taking some hypertension medications, fewer than 30 percent reported that they had high blood pressure. This finding suggest that if they were told, they did not understand or misinterpreted the significance of the numbers.

An important observation in the study was that patients who had blood pressures of more than 140 mm Hg did not believe that they had high blood pressure. This finding, however, is not surprising. It often takes several years for new definitions to filter down to the medical
community and the general public. There are still many physicians who do not believe that cardiovascular risk is increased until systolic
blood pressures rise above 150 to 160 mm Hg."

Dr. Moser concludes that "Patients should be advised that if their blood pressures remain at or above 140.90 mm Hg, they should ask their physician why. It is important to convince patients that medication does not necessarily result in sexual dysfunction, loss of cognitive function, or other ongoing symptoms. The message should be that people may feel better with lower blood pressures, another benefit that far outweighs the risk, even in elderly patients."

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