After years of improvement, the number of Americans whose blood pressure (BP) is under control is declining, suggesting two new analyzes of data from National Health and Nutrition Examination Survey (NHANES).
One Virtually Published Analysis of the American Heart Association (AHA) High blood pressure At the 2020 conference, it was found that Americans with proper blood pressure control (defined as <140/90 mmHg) decreased by 11% between 2013-2014 and 2017-2018.
“I don’t think the improvement in blood pressure control will continue after 35 years of success,” said lead author Brent M. Eagan, MD, MD, University of South Carolina School of Medicine, in a news release.
A similar pattern was observed in another report based on data from more than 18,000 NHANES participants with hypertension. According to the analysis, BP control increased from about 54% in 2013 to 2014 to about 2017 to 2018, even though the increase in BP control was encouraged from 1999 to 2000 to 2013 to 2014. It decreased significantly to 44%.
Those who visited a healthcare provider within the past year were six times more likely to have controlled blood pressure than those who did not.
“It was amazing what we found,” Reed said. Author Dr. Paul Mantner, Professor of Epidemiology and Associate Professor of Research, Faculty of Public Health, University of Alabama at Birmingham, Medscape Medical News..
“We have found that the strongest predictor of uncontrolled BP does not go to the doctor. This is particularly relevant at this time of COVID-19, and so many people I’m afraid to go to the doctor for a follow-up visit. I’m exposed to people who may be infected. “
This study Published online September 9 JAMA..
Reverse the year of progress
2014, 8th Joint National Committee Hypertension Guidelines (Jnc8) Raised the blood pressure target for adults over 60 years of age to less than 150/90 mmHg without developing diabetes. However, in 2017 the American College of Cardiology and the American Heart Association (AHA / ACC) Guidelines This reduced the blood pressure target for all adults to less than 130/90 mmHg.
Eagan and his colleagues said that prior to the JNC8 guidelines, blood pressure control in NHANES participants rose from 32.2% in 1999–2000 and peaked at 54.5% in 2013–2014, then 48.0 in 2015–2016. I found that it dropped to%. From 2017 to 2018, it decreased to 43.4%.
“Despite the 2017 BP target of <130 / <90 for all adults, control of <140 / <90 continued to decline in 2017-2018," the authors report. There was a 11.1% decrease from 2013-2014 (P <.001).
The number of adults aged 40-59 years who were successfully treated for BP decreased by almost 10% between 2009-2012 and 2015-2018 (56.3% vs. 46.6%). In adults over the age of 60, it decreased by 6% (from 53.6% to 47.9%).
Systolic blood pressure (SBP) increased by 3-4 mmHg in all age groups (P <.01).
The authors found that decreased blood pressure control in adults age 60 and older reflected decreased treatment efficiency, whereas decreased blood pressure control in adults aged 40-59 reflected decreased awareness and treatment. It has said.
“Therefore, the loss of control was not well explained in the BP goal for adults over the age of 60 and subsequent controversy,” they said.
“Curious” discovery
In another report by Muntner and colleagues published in JAMA, Researchers analyzed cross-sectional data on NHANES starting in 1999-2000 and ending in 2017-2018.
In particular, of the total number of participants included in the NHANES analysis (N = 51,761 participants), 18,262 participants with hypertension (defined as BP ≥ 140/90 mmHg or antihypertensive drug use) (18 years and older) ) Data were analyzed; average age, 48 years, 50.1% of women).
Of the participants, 43.2% were non-Hispanic white adults, 26.1% were Hispanic adults, 21.6% were non-Hispanic black adults, and 5.3% were non-Hispanic Asian adults.
Of the 18,262 participants with hypertension, the age-adjusted estimated proportion of patients with controlled blood pressure increased between 1999-2000 and 2007-2008 (P <.001), 2007-2008-2013-2014 (P <.14), but rejected during 2017-2018 (P <.003).
| Limit | Participants with blood pressure control (%) |
|---|---|
| 1999-2000 | 31.8 |
| 2007 – 2008 | 48.5 |
| 2013-2014 | 53.8 |
| 2017 – 2018 | 43.6 |
Controlled blood pressure was higher in 45-64 years (49.7% vs 36.7%) and lower in 75 years and older (37.3% vs 36.7%) compared to adults aged 18-44 years.
Dramatic differences in blood pressure control between those who have regular health care facilities and those who do not (48.4% vs. 26.5%) and those who have not visited a healthcare provider in the past year (49.1%) had. 8.0%).
“This is a bit of a concern, and our findings reinforce the message that it is important to go to the doctor and check the blood pressure, and if it is high, the patient is on medication. You can start or adjust the dose, “Commenter commented.
Racial disparity
Non-Hispanic black adults were less likely to control blood pressure than non-Hispanic white adults. Individuals without health insurance were also less likely to successfully manage their blood pressure.
Similar to the findings of Eagan and colleagues, hypertension awareness increased between 1999-2000 and 2013-2014 (from 69.9% to 84.7%), but decreased to 77.0% between 2017-2018. did.
In 2017–2018, awareness of having hypertension was higher among non-Hispanic black participants compared to non-Hispanic whites, Asians, and Hispanic participants, but blood pressure control. Was low.
“There are good public health campaigns among African Americans to raise awareness of high blood pressure, and they are likely to be treated as well, but the rate of blood pressure control is a bit lower,” Mantner observes. Did.
“I think it’s important to make it accessible to everyone. [to care], Has a pharmacy or mail-order pharmacy where everyone can get the right medicines that are effective in reducing inequality and lowering blood pressure, “he added.
Addressing inequality
Comment on both studies Medscape Medical News“Unfortunately, the recent increase in adults who have lost control of BP reflects the 2014 recommendations to ease control,” said Robert M. Carrie, a professor of medicine at the University of Virginia, Charlottesville, University of Virginia. However, in 2017, the importance of strict blood pressure control was reaffirmed and the target blood pressure was lowered by the 2017 ACC / AHA practice guidelines. “
Carrie was co-chair of the 2017 ACC / AHA Guidelines Development Committee and was not involved in either investigation. “The findings do not reflect changes in blood pressure management after the 2017 guidelines were published and disseminated to the clinical practice community, and we can expect improved management as a result of the guidelines’ recommendations,” he said. Stated.
Paul Whelton, MB, MD, Show Chwan Chair in Global Public Health, Department of Epidemiology Tulane University School of Public Health and Tropical Medicine Tulane University of Medicine, New Orleans, Louisiana agreed. In recommending a higher level of BP control, the JNC8 report probably “caused the confusion that people might have said,” you can retreat and you don’t have to be that strict. ” He said, said Medscape Medical News..
Wellton was chair of the 2017 ACC / AHA Guidelines Development Committee and was not involved in either investigation. He emphasized that lifestyle improvement “should be a core management strategy for the prevention and treatment of hypertension, and that drugs should be added in certain situations.”
so editorial Accompanied by the report JAMA, Gregory Curfman, MD, and colleagues said, “It is important to repeat the analysis of Muntner et al within another five years to determine if progress has been achieved in accordance with the instructions of the United States in 2017 and 2018. Will be European guidelines“
The second editorial To JAMAWritten by Dr. Griffin Rogers and Dr. Gary Gibbons, MD, National Institutes of Health, non-Hispanic black adults have poorer blood pressure control than non-Hispanic white adults.
“If the United States is committed to changing the trendline for health inequalities obesity And for hypertension, it is important to recognize the significant contributions of racism and social determinants of health in the context of the current COVID-19 crisis, “they write.
In a statement jointly released by the American Medical Association (AMA) and AHA, AMA President Susan R. Bailey, MD, and AHA President Mitchell SV Elkind, said that Mantner and his colleagues had studied. Cardiovascular disease increases the risk of adverse outcomes associated with COVID-19, emphasizing the need for all healthcare professionals and their patients to prioritize blood pressure control. “
AMA has developed a framework to improve blood pressure control, Online resources To give clinicians easy access to up-to-date evidence-based guidance on the management of hypertensive patients. Part of the AMA-AHA joint Target: BP Initiative.
In addition, AMA and AHA, in collaboration with a group of national medical institutions and ESSENCE, Release the pressure campaign Advocate for improving the heart health of black women.
The authors of the study are supported by the National Heart, Lung, and Blood Institute. Muntner received grants and consulting fees from Amgen, Inc. The original article lists the relevant financial relationships of other authors. Carey, Whelton, Curfman and co-authors Rogers and Gibbons have not revealed such a financial relationship.
Hypertension Science Session 2020 Virtual Meeting: Presentation MP33, Session MP07.
JAMA. Published online September 9, 2020. Full textCalfman and others editorialRogers and others editorial
