High Blood Pressure Prevalent, but Better Controlled

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Half of Americans With High Blood Pressure Have the Condition Under Control, but Hypertension Is on the Rise

By Daniel J. DeNoon
WebMD Health News

Reviewed By Laura J. Martin, MD

May 25, 2010 -- Half of Americans with high blood pressure now have the condition under control, but more and more Americans are coming down with the dangerous condition.

For a long time, it didn't look as though Americans would reach the U.S. Healthy People 2010 goal of having 50% of people control their high blood pressure. Only 27.3% of people with hypertension -- the medical term for high blood pressure -- controlled it between 1988 and 1994.

But now, Brent M. Egan, MD, and colleagues at the University of South Carolina report that by 2007-2008, 50.1% of Americans with hypertension got their blood pressure below 140/90.

It's "cause for celebration," says Boston University researcher Aram Chobanian, MD. But Chobanian cuts the festivities short by quickly observing that more than 30% of Americans have high blood pressure and at least 30% more have prehypertension, which also increases risk of heart disease.

The Egan study's sobering second finding is that more Americans have high blood pressure than ever before.

High Blood Pressure Treatment: Drugs vs. Lifestyle Change

What's going on? Researchers variously blame obesity for as little as 20% and as much as 80% of high blood pressure. And unless you never read health news, you already know that about a third of Americans are obese.

This means even the good news about hypertension control is shaded by some bad news. The best way to lower high blood pressure is to lose weight and exercise more. But Egan and colleagues find no evidence that weight loss or exercise had anything to do with the nation's improved blood pressure control.

Instead, the reason seems to be improved medical treatment.

"The availability of a broad array of effective anti-hypertensive drugs with excellent tolerability has made treatment easier than in the past," Chobanian says. "Major changes toward healthier lifestyles have not occurred in the United States ... and would not appear responsible for the observed improvement."

And even this armamentarium of new drugs has a dark side, according to a study by Stanford University researcher Randall S. Stafford, MD, PhD, and colleagues.

Stafford and colleagues' landmark 2002 ALLHAT study showed that inexpensive thiazide-type diuretics are at least as effective as newer, more expensive drugs and should be the bedrock of drug treatment for most patients (while lifestyle change should be the bedrock of overall treatment).

However, the ALLHAT findings had little impact on doctors' prescribing habits. The Stafford study finds that doctor education increases prescribing of thiazide diuretics. But overall, U.S. use of these drugs did not increase from 2004 to 2008.

High Blood Pressure: What About the Other Half?

Half of Americans with high blood pressure still aren't doing what it takes to get their blood pressure under control.

The Egan study finds that different populations will benefit from different strategies:

  • Hispanic Americans with high blood pressure need more screening and referral to primary care.
  • African-Americans with high blood pressure need more emphasis on treatment effectiveness.
  • Men with high blood pressure need more hypertension awareness and treatment.
  • Women with high blood pressure need more emphasis on hypertension control.

The Egan study and the Chobanian editorial appear in the May 26 issue of the Journal of the American Medical Association. The Stafford study appears in the May 24 issue of Archives of Internal Medicine.

Egan and colleagues and Chobanian report no financial disclosures. Stafford reports consulting for Bayer Corp. and having grants and/or contracts with Procter & Gamble, GlaxoSmithKline, Toyo Shinyaku, and Wako.

SOURCES: Egan, B.M. Journal of the American Medical Association, May 26, 2010; vol 303: pp 2043-2050.

Chobanian, A.V. Journal of the American Medical Association, May 26, 2010; vol 303: pp 2082-2083.

Stafford, R.S. Archives of Internal Medicine, May 24, 2010; vol 170: pp 851-858.

Avorn, J. Archives of Internal Medicine, May 24, 2010; vol 170: pp 858-860.

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