Trends in Uncontrolled Hypertension Are Reversing

Despite previously promising trends, blood pressure (BP) control in the United States has decreased in recent years, according to a new study¹ presented at the American Heart Association’s Hypertension Sessions 2020. Between 2013 and 2018, there was an 11.1% decrease in the percentage of US adults with controlled hypertension.

“A closer look at our findings revealed the fall in blood pressure control in older adults was mainly due to less effective use of blood pressure medication and management, so we need to focus on making sure the level of treatment is adequate for this age group,” said lead author of the study, Brent M. Egan, MD, in a press release.² “We found the decrease in blood pressure management among the 40-59 age group was mainly due to lack of awareness of and treatment for hypertension.”

To analyze the trends in BP control and percentage of individuals who maintained BP control from 2009 to 2018, the researchers analyzed data from the National Health and Nutrition Examination Survey (NHANES) in groupings before (2009-2012) and after (2015-2018) the American Heart Association’s BP goal was increased to less than 150/90 mm Hg. Data was also assessed by age group: 18 to 39 years, 40 to 59 years, and 60 years or older.

The American Heart Association’s current definition of hypertension is 130/80 mm Hg or higher, but for the purpose of this study, the researchers defined elevated blood pressure as 140/90 mm Hg or higher.

Responses to “Have you been told you have hypertension?” were assessed for awareness, and treatment efficacy was also assessed.

Overall, BP control peaked in 2013 to 2014, with 54.4% of participants reporting BP at or below the threshold. The percentage declined to 48.0% in 2015 to 2016 and to 43.4% in 2017 to 2018. When the researchers compared the results from 2015-2018 with data from 2009-2012, they saw that BP control, awareness of hypertension, and treatment efficacy decreased among adults aged 40 to 59 years; BP control and treatment efficacy decreased among adults aged 60 years or older; and systolic BP increased 3 to 4 mm Hg in all age groups.

“We cannot assume improvement in blood pressure management will continue, even after 35 years of success,” Dr Egan concluded.² “High blood pressure is a serious health risk and deserves constant attention to prevent as many heart attacks and strokes as possible.”

—Leigh Precopio

References:

1. Egan BM, Li J, Sutherland SE, Rakotz M, Wozniak G. Hypertension control in the U.S. 2009 to 2018: rapid reversing years of progress. Paper presented at: American Heart Association’s Hypertension 2020 Scientific Sessions; September 10-13, 2020; Virtual.
2. Americans continue to struggle controlling high blood pressure; 11% fewer adults have it in check. News release. September 9, 2020. Accessed September 9, 2020. https://newsroom.heart.org/news/americans-continue-to-struggle-controlling-high-blood-pressure-11-fewer-adults-have-it-in-check