High Blood Pressure Control, Awareness on the Decline Among U.S. Adults

By Jonathan Springston, Editor, Relias Media

The recently published results of a study suggest the percentage of Americans who are aware of high blood pressure and the importance of controlling those numbers may be on the decline, reversing a decade-plus upward trend.

Researchers conducted a serial cross-sectional analysis of National Health and Nutrition Examination Survey (NHANES) data collected between 1999 and 2018. They searched for trends in high blood pressure awareness, treatment, and control. The group identified 18,262 U.S. adults age 18 years and older with hypertension, defined as blood pressure 140/90 mmHg or higher. Patients who recorded blood pressure readings lower than this threshold were considered to be in control of their pressure.

Through their data analysis, the authors learned that in the 1999-2000 period, 70% of NHANES participants were aware of their condition. By the 2013-2014 period, that reached 85%. But by the 2017-2018 period, awareness had declined to 77%.

Of all adults with high blood pressure, the percentage of participants who controlled their pressure went from 32% in 1999-2000 to 54% in 2013-2014 back to 44% in 2017-2018. Among those with controlled pressure, the percentage taking medication climbed from 53% in 1999-2000 to 72% in 2013-2014 before dipping to 65% in 2017-2018.

“The reversal in hypertension awareness is a real set back in the fight to reduce heart disease and stroke,” Paul Muntner, PhD, lead study author and associate dean for research in the School of Public Health at the University of Alabama at Birmingham, said in a statement. “While lifestyle factors are big contributors to hypertension, awareness and appropriate treatment are key to lowering blood pressure and keeping it in a healthy range to greatly reduce the risk for heart disease and stroke.”

Digging deeper, Muntner and colleagues found Americans age 60 years and older as well as Black Americans as a group were less likely to control their blood pressure vs. white Americans and those aged 18-44 years in the 2015 to 2018 period. However, NHANES participants on Medicaid were more likely to be in control of their pressure vs. those with no health insurance. Further, the percentage of NHANES participants who were aware of their condition and taking proper medication remained mostly steady: 85% in 1999-2000, 89% in 2013-2014, and 88% in 2017-2018.

A joint statement released by the American Medical Association and the American Heart Association called the results of this analysis “extremely troublesome.”

“Despite the fact that we have more scientific evidence than ever before pointing to the devastating effects of uncontrolled high blood pressure, as well as broader access to low-cost generic medications to treat the condition, blood pressure control has worsened,” the groups wrote. “This research reinforces the need for all healthcare providers and their patients to prioritize blood pressure control, especially now as cardiovascular disease places people at greater risk for adverse outcomes associated with COVID-19. The data also highlight the need for us to address upstream factors, including structural racism, that continue to contribute to the greater prevalence of hypertension and lower rates of blood pressure control among Black, Latino, Asian and indigenous populations compared to white adults.”

For more on this study and related subjects, be sure to read the latest issues of Clinical Cardiology Alert.