Nearly three-fourths of American adults with conditions such as coronary heart disease, stroke, diabetes or others that raise their risk for cardiovascular complications also have hypertension (high blood pressure), according to a report in the December 10/24 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. Although about 75 percent of these individuals are being treated for hypertension, only one-third to one-half are reaching blood pressure goals.
Blood pressure control remains a problem in the United States and around the world, according to background information in the article. "Recent estimates indicate little change in the prevalence of hypertension, and, although there seem to be some recent improvements in treatment and control rates, hypertension in many persons remains inadequately controlled," the authors write.
Nathan D. Wong, Ph.D., of the University of California, Irvine, and 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 (including blood pressure measurements).
A total of 1,671 (31.4 percent) of the participants had hypertension, defined as a systolic (top number) blood pressure of at least 140 milligrams of mercury (130 milligrams of mercury in those with diabetes or chronic kidney disease) or a diastolic (bottom number) blood pressure of at least 90 milligrams of mercury (80 milligrams of mercury in those with diabetes or chronic kidney disease), or as reporting use of a blood pressure-lowering medication. The condition was more common in older and black 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.
High blood pressure was found in most persons with cardiovascular diseases and related problems, including:
- 76.8 percent of those with diabetes
- 81.8 percent of those with chronic kidney disease
- 69.5 percent of those with stroke
- 71.4 percent of those with congestive heart failure, which occurs when the heart can't pump enough blood to the rest of the body
- 73.7 percent of those with peripheral artery disease, or narrowed veins or arteries
- 73 percent of those with coronary artery disease
- 76.9 percent of those with two or more of these diseases
Among individuals with these conditions, 75 percent or more were being treated for hypertension, but only one-third to one-half of those in treatment reached goal levels for blood pressure (140/90 milligrams of mercury for most patients, or 130/80 milligrams of mercury for patients with diabetes or chronic kidney disease). Goal attainment rates were particularly low for persons with stroke (34.9 percent), heart failure (48.8 percent), peripheral arterial disease (46.7 percent) and coronary artery disease (50.3 percent).
With the lower goal for persons with diabetes and chronic kidney disease, only 35 percent and 23 percent, respectively, were controlled for their blood pressure. Those who were uncontrolled had systolic blood pressure that averaged at least 20 higher than the goal. "Poor control rates of systolic hypertension remain a principal problem that further compromises the already high cardiovascular disease risk" in these individuals, the authors write. "Moreover, given recently released recommendations to reduce the blood pressure goal to less than 130/80 milligrams of mercury for persons with coronary artery disease and other high-risk conditions, our hypertension control rates would be even lower and a greater distance from the goal for these persons if the new criteria are applied."
"These high-risk persons with low rates of hypertension control represent an urgent need for intensified efforts to achieve blood pressure control," they conclude.
(Arch Intern Med. 2007;167(22):2431-2436. Available pre-embargo to the media at www.jamamedia.org.)
Editor's Note: This study was supported by a contract from Bristol-Myers Squibb to the University of California, Irvine. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Editorial: Research Must Examine Reasons for Slow Translation of Guidelines into Clinical Practice
Several potential explanations exist for the gap between recommended treatment goals--such as target blood pressure ranges--and clinical practice, writes Theodore A. Kotchen, M.D., of the Medical College of Wisconsin, Milwaukee, in an accompanying editorial.
"These reasons may include the complexity or difficulty of achieving the recommended guidelines, patient or physician behavior and/or deficiencies in the system of health care," Dr. Kotchen writes. "Developing effective strategies to address the slow pace of dissemination into health care will require a better understanding of the potential barriers."
(Arch Intern Med. 2007;167(22):2394-2395. Available pre-embargo to the media at www.jamamedia.org.)
Editor's Note: Please see the article for additional information, including author contributions and affiliations, financial disclosures, funding and support, etc.
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