Up to half of hypertension patients are not reaching blood pressure goals

Nearly three-fourths of American adults with coronary heart disease, stroke, diabetes or other conditions that raise the risk for cardiovascular complications also have high blood pressure, according to a University of California, Irvine study.

The report, which appears in the Dec. 24 issue of the Archives of Internal Medicine, also notes that although 75 percent of these individuals are treated for hypertension, only one-third to one-half reach blood pressure goals.

“Blood pressure control remains a problem in the United States and around the world,” said Nathan Wong, director of the UC Irvine Heart Disease Prevention Program and study leader. “Recent estimates indicate little change in the prevalence of hypertension, and, although there seem to be some improvements in treatment and control rates, hypertension in many persons remains inadequately controlled.”

Wong and his colleagues analyzed data from adults participating in the National Health and Nutrition Examination Survey, a nationally representative survey conducted by the Centers for Disease Control and Prevention. In 2003 and 2004, 4,646 adults (representing 192 million nationwide) provided demographic and socioeconomic information and underwent laboratory and physiological testing, which included blood pressure measurements.

Nearly a third of the participants had hypertension, which is defined as a systolic (top number) blood pressure of at least 140 milligrams of mercury or a diastolic (bottom number) blood pressure of at least 90 milligrams of mercury. Another indication was reported use of a blood pressure-lowering medication. Hypertension was more common in older and African American adults.

A total of 68.5 percent of those with hypertension were being treated, and 52.9 percent of those had their hypertension under control. Unique to this study, however, is that high blood pressure was found in most persons with cardiovascular diseases and related problems, including:

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76.8 percent of those with diabetes;
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81.8 percent of those with chronic kidney disease;
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69.5 percent of those with stroke;
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71.4 percent of those with congestive heart failure, which occurs when the heart can’t pump enough blood to the body;
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73.7 percent of those with peripheral artery disease, or narrowed veins or arteries;
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73 percent of those with coronary artery disease; and
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76.9 percent of those with two or more of these diseases.

Of these patients who are being treated for hypertension, those reaching their blood pressure goal, or control rate, were particularly low for persons with stroke (35 percent), heart failure (49 percent), peripheral arterial disease (47 percent), and coronary artery disease (50 percent).

Of persons with diabetes and chronic kidney disease, who are advised to keep their blood pressure rates below 130/80, only 35 percent and 23 percent, respectively, reached their blood pressure goals.

“The low control rate for stroke, in particular, is especially unfortunate given that hypertension is the major risk factor for stroke,” Wong said. “Poor control rates of systolic hypertension remain a principal problem that further compromises the already high cardiovascular disease risk.”

The study was supported by a contract from Bristol-Myers Squibb to UC Irvine.


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