Race and Medicine

Race and Medicine

Disclosures: Muntner reports he received grant funding and consultant fees from Amgen. Fine reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
September 09, 2020
6 min read

Trends in BP control highlight age, race disparities in hypertension treatment, education

Disclosures: Muntner reports he received grant funding and consultant fees from Amgen. Fine reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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Despite significant improvements in BP control among U.S. patients with hypertension between 1999 and 2013, there was an approximately 10% drop in BP control from 2013 to 2018, researchers reported.

In addition, the researchers found a reduced prevalence of BP control among non-Hispanic Black patients compared with non-Hispanic white patients.

blood pressure cuff
Source: Adobe Stock.

These findings, published in JAMA, concur with a similar study presented at the virtual American Heart Association Hypertension Scientific Sessions, in which researchers found that BP control dropped more than 11% during the same period.

“The reversal in hypertension awareness is a real setback in the fight to reduce heart disease and stroke,” Paul Muntner, PhD, professor and associate dean for research in the School of Public Health at the University of Alabama at Birmingham, said in a press release. “While lifestyle factors are big contributors to hypertension, awareness and appropriate treatment are key to lowering blood pressure and keeping it in a healthy range to greatly reduce the risk for heart disease and stroke.”

Downward trend in BP control

Using data from the National Health and Nutrition Examination Survey, investigators analyzed trends in BP control from 1999-2000 to 2017-2018, totaling 10 survey cycles. This assessment included 51,761 U.S. adults (mean age, 48 years; 50% women; 22% non-Hispanic Black), of whom 18,262 had hypertension, defined at systolic BP of 140 mm Hg or more or reported use of an antihypertensive medication. The primary outcome was prevalence of BP control, and secondary outcomes were BP control in several subgroup analyses.

Among NHANES participants with hypertension, the age-adjusted proportion with BP under control increased from 31.8% in 1999-2000 (95% CI, 26.9-36.7) to 48.5% in 2007-2008 (95% CI, 45.5-51.5). By 2013-2014, BP control among participants with hypertension increased to 53.8% (95% CI, 48.7-59) but dropped to 43.7% in 2017-2018 (95% CI, 40.2-47.2).

Researchers estimated that successful BP control was more likely among patients aged 45 to 64 years vs. those aged 18 to 44 years (adjusted prevalence ratio [aPR] = 1.18; 95% CI, 1.02-1.37) and less likely among patients aged at least 75 years (multivariable-adjusted PR = 0.81; 95% CI, 0.65-0.97), according to the study.

“Reversing this decline is important because we don’t want to lose public health achievements built over prior decades,” Lawrence Fine, MD, chief of the Clinical Applications and Prevention Branch at NHLBI and a study co-author, said in the release. “It is a challenge for the scientific community to investigate the causes of this unexpected downward trend, but developing more effective strategies to reverse and substantially improve blood pressure control is critical for the health of many Americans.”

Subgroup analyses for BP control

The researchers estimated that BP control was less likely among non-Hispanic Black adults compared with non-Hispanic white adults (aPR = 0.88; 95% CI, 0.81-0.96).

Moreover, successful BP control was more likely among the following subgroups:

  • those with private insurance compared with those without (aPR = 1.4; 95% CI, 1.08-1.8);
  • with Medicare compared with those without (aPR = 1.47; 95% CI, 1.15-1.89);
  • with other government health insurance compared with those without (aPR = 1.36; 95% CI, 1.04-1.76);
  • those with a usual health care facility compared with those without (aPR = 1.48; 95% CI, 1.13-1.94); and
  • among those who had a health care visit in the past year compared with those without (aPR = 5.23; 95% CI, 2.88-9.49).

“Educating patients and providers on blood pressure goals, adding effective blood pressure medications when lifestyle changes aren’t enough, and reducing barriers to achieve high medication adherence in a variety of clinical practice settings are just a few strategies that may facilitate increases in blood pressure control rates and reduce health disparities we identified in the current study,” Muntner said in the release.