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Hypertension control improved over past two decades

JAMA 2010; 303: 2043–2050

Hypertension control has improved significantly since the late 1980s, with most of the improvement occurring after 1999, analysis of US NHANES data shows.


Brent Egan (Medical University of South Carolina, Charleston, USA) and colleagues report that hypertension control – representing the product of hypertension awareness, the proportion of affected people who received antihypertensive treatment, and the proportion of those treated who achieved blood pressure (BP) control targets – increased from just over a quarter of affected people in 1988–1990 to around one half in 2007–2008.

The findings reflect a significant trend for improvement overall, and that most of the progress towards achieving the Healthy People 2010 goal of 50% of hypertension controlled was made between 1998 and 2008, say the authors.

"However, prevalent hypertension is not decreasing towards the national goal of 16% and will likely remain high unless adverse trends in population nutrition and body mass index occur or pharmacological approaches to hypertension are adopted," they add.

The researchers compared data from the 2007–2008 NHANES (National Health and Nutrition Examination Survey) with earlier data for NHANES dating back to 1988, including a total of 42,856 adults older than 18 years.

Their results showed that rates of hypertension (BP at least 140/90 mmHg, self-reported anti-hypertensive medication, or both) increased from 23.9% in 1998–1994 to 28.5% in 1999–2000 (p<0.001), but then did not change significantly by 2007–2008, at 29.0%.

The proportion with their hypertension controlled (BP less than 140/90 mmHg) meanwhile increased from 27.3% in 1988–1994 to 50.1% in 2007–2008 (p for trend=0.006).

However, Egan et al observe that BP control improved significantly more in absolute percentages between 1999–2000 and 2007–2008 than between 1988–1994 and 1999–2000, at 18.6% versus 4.1% (p<0.001).

The improvement in hypertension control reflected greater awareness, which increased from 69% to 81% from 1988–1994 to 2007–2008, more patients receiving treatment, which correspondingly increased from 54% to 73%, and more treated patients achieving control, which increased from 51% to 69%.

Further analysis showed that, while hypertension control improved across age, race, and gender groups, it was lower among individuals aged 18–39 years than those aged 40–59 years and 60 years and older, and in Hispanic than White people.

Aram Chobanian (Boston University, Massachusetts, USA) commented in a related editorial that the findings are "cause for some celebration" but that challenges remain.
"Although lifestyle changes can reduce BP and the risk of developing hypertension, successful behavioural approaches to modify lifestyles on a population basis have lagged far behind the advances in the drug treatment of hypertension," he wrote. "Programs to incorporate healthier lifestyles into daily life need to be intensified on a national basis to deal with not only hypertension but also obesity, diabetes, dyslipidemias, and cardiovascular diseases."

Read the abstract


MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2010