Daniel T. Lackland, DrPH on hypertension control’s implementation problem.

Hypertension

America’s Hypertension Awareness and Control Problem

Nearly half of American adults have hypertension, and a new JAMA study reveals that the vast majority of them don’t have their blood pressure under control, while most don’t even know they have the disease.

• Estimates suggest that 120M U.S. adults have hypertension, while uncontrolled hypertension is associated with $131B-$198B in annual healthcare costs. 
• Uncontrolled hypertension is a leading risk factor for CVD mortality and events, and is associated with diabetes, CKD, and cognitive decline.

To better understand our hypertension control challenges, a CDC team analyzed 2017-2020 NHANES survey data featuring 7,328 U.S. adults (3,954 w/ hypertension) and revealed some alarming population-wide estimates…

• 79.1% of the participants with hypertension didn’t have their blood pressure under control, representing a whopping 100M Americans.
• 57.6% of the participants with hypertension didn’t even know they had the disease, representing 57.8M people.
• Of the 35M who were actually aware of their hypertension and qualified for antihypertensive medication, just 30% got their hypertension under control. 

These gaps in hypertension care can’t be blamed on patients not being engaged…

• 70% of all adults with uncontrolled hypertension had two or more healthcare visits during the previous year, and around half of these participants were still unaware of their hypertension status.

America’s hypertension control breakdown also isn’t just limited to older adults…

• An estimated 30M Americans aged 18 to 44 have hypertension, and over 93% of them don’t have their BP under control.
• Around 68% of those younger Americans don’t even know they have hypertension.

Given these hypertension challenges, the authors and commenters called for the adoption of evidence-based strategies to improve hypertension awareness and management, noting that the BP control strategies that we have work… if they’re implemented correctly.

The Takeaway

Considering hypertension’s massive prevalence, significant health impact, and numerous treatment options, there’s plenty of reasons for BP testing and treatment to be at the center of most patients’ care. However, this study highlights how many implementation improvements are needed before America can get its hypertension problem under control.

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The Wire

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The Resource Wire

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