October 5, 2020Cardiology
High blood pressure, also called hypertension, is a major risk factor for heart disease. According to the Centers for Disease Control and Prevention (CDC), nearly 108 million Americans have hypertension, with a blood pressure reading of 130/80 millimeters of mercury (mm Hg) or higher or are taking medication for their blood pressure, but only 27 million are considered to have their blood pressure under control, despite it being a condition that can be managed.
According to a recent study published online on Sept. 9 in JAMA, after nearly 15 years on an upward trend, awareness among Americans about high blood pressure and how to control and treat it is now on the decline,. Even with the help of blood pressure medications, some groups, including older adults, are less likely than they were in earlier years to adequately control their blood pressure. According to the authors, this trend could make longstanding efforts to fight heart disease and stroke - leading causes of death in the United States - even more challenging.
The study included 18,262 U.S. adults age 18 and older, with high blood pressure. The definition of hypertension at the time of the study was defined by a blood pressure reading of 140/90 mm Hg or higher or by treating the condition with blood pressure medications. Participants with a blood pressure reading of less than 140/90 mm Hg were categorized as having controlled blood pressure. With data from the National Health and Nutrition Examination Survey (NHANES) taken between 1999 and 2018, the study authors looked at 20-year trends in high blood pressure awareness and treatment and blood pressure control. At the beginning of the survey, participants had their blood pressure measured three times, then averaged. Participants answered yes or no when asked if their doctors told them they had high blood pressure and if they currently took prescribed medication for high blood pressure. Results showed that in 1999-2000, just 70% of participants showed an awareness of their condition. That number increased steadily to 85% in 2013-2014, but declined to 77% in 2017-2018. Of those aware adults, the number who also were taking blood pressure medications remained relatively consistent - 85% in 1999-2000, 89% in 2013-2014, and 88% in 2017-2018.
Of all adults with high blood pressure, the number who managed to control their condition increased from 32% in 1999-2000 to 54% in 2013-2014, but then declined to 44% in 2017-2018. Of those adults with controlled blood pressure, the number taking blood pressure medication increased from 53% in 1999-2000 to 72% in 2013-2014, then declined to 65% in 2017-2018. According to the authors, these observations underscore the importance of continuity of care, including having a usual source of care and regularly scheduled healthcare visits that could increase high blood pressure awareness and treatment and blood pressure control among adults.
Interestingly, when broken down by age, between 2015 to 2018, adults age 60 and older, as well as African Americans as a group, were less likely than adults ages 18 to 44 and whites as a group to have controlled blood pressure. Also, participants with Medicaid as their health insurance, were more likely to have their blood pressure under control than those without health insurance.
According to the authors, the following are several effective strategies that may facilitate increases in blood pressure control rates and reduce health disparities identified in the current study:
1. Educate patients and providers on blood pressure goals
2. Add effective blood pressure medications when lifestyle changes aren't enough
3. Reduce barriers to achieve high medication adherence in a variety of clinical practice settings