For treating high blood pressure, more is more

If you have high blood pressure that’s under control, you’re in good company. According to a new report from the American Heart Association, just under half of American adults with high blood pressure now have the condition well managed with medication.

This is a major improvement compared to 10 years ago, when only one out of three hypertensive adults had their blood pressure under control. The gains also underscore a growing body of evidence that when it comes to successfully treating high blood pressure, more is more: Most patients just do better when they’re taking more than one medication for hypertension.

The report appears in the Circulation journal and is based on data collected from 9,320 participants in the National Health and Nutrition Examination Survey from 2001 to 2010. High blood pressure was defined as 140/90 mm Hg or greater (130/80 mm Hg for those with diabetes or kidney disease).

As chronic conditions go, high blood pressure is common, especially in people who are middle-aged and older. Although there’s often a perception that hypertension is becoming more widespread, the overall prevalence has been more or less unchanged for many years, hovering at around 30 percent overall of the American adult population.

What does seem to be changing is that people who are hypertensive are more aware of it. They’re increasingly likely to be told by a doctor or other health care professional that they have high blood pressure, and they’re increasingly likely to be prescribed medication to treat it.

Some telling figures from a brief published in 2010 by the National Center for Health Statistics: The overall percentage of adults with high blood pressure who were aware they had the condition rose from 69.6 percent in 1999-2000 to 80.6 percent in 2007-2008. And the percentage of those being treated with medication for it grew from 59.4 percent to 71.6 percent over the same time period. (The figures come from NHANES, the same source as the new American Heart Association report.)

Important as these measures are, however, what matters most is whether these people have their high blood pressure actually under control. This metric is what the Heart Association report examines, and despite the fact that there’s still often a gap between aspiration and success, the picture is encouraging.

What accounted for all this progress? The authors single out what appears to be the key factor: the growing use of multiple drugs for treating high blood pressure. Overall, the number of study participants taking multiple drugs for high blood pressure increased from 36.8 percent in 2001 to 47.7 percent in 2010. Outcomes tell the tale: The participants were much more likely to meet their blood pressure goals when they were prescribed two or more medications for hypertension.

Significantly, the survey also confirms progress in blood pressure control in the wake of new treatment guidelines, published in 2003 by the Joint National Committee, that call for greater use of combination drug therapy to achieve and maintain acceptable blood pressure levels. In other words, doctors have been taking these evidence-based guidelines to heart when managing their patients with hypertension.

There’s room for improvement, though. In the bigger picture, about half of Americans with high blood pressure still don’t have it under control. The researchers found that thiazide diuretics, recommended as initial treatment for uncomplicated hypertension, still aren’t being prescribed often enough.

The study authors also noted some worrisome disparities: Older adults, African Americans and people with diabetes or chronic kidney disease were more likely to fall short of blood pressure goals despite treatment. “More efforts are needed to close the gap between treatment and control and to maximize the public health and clinical benefits among those high-risk subpopulations,” the authors concluded.

One thought on “For treating high blood pressure, more is more

  1. There are many things leading to improved awareness, but Minnesota needs to take credit for one of them: retail health clinics. The most at-risk demographic for early hypertension is exactly that demographic that never gets medical care, other than when ill. This is exactly the demographic that MinuteClinic, originally a Minnesota company, targeted at the beginning. Everyone who came in for bronchitis or a cold or whatever had the blood pressure checked, and, if it was high, at least got some education. “Many” received ongoing treatment, but we unfortunately have no way to track that. I’ve been a medical director for MinuteClinic for several years, and the main reason is that I feel strongly that such retail health clinics (there is plenty of competition now) are a critical part of the nation’s safety net with regard to health care. Any access we have to the demographic that generally flies under the health care radar is a wonderful opportunity!

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