Perspective from Matthew Solomon, MD, PhD
Perspective from Eugene Yang, MD, FACC
Perspective from Seth Shay Martin, MD, MHS
Disclosures: Paul reports being an employee of AstraZeneca; acting as a consultant or speaker for Amylin Pharmaceuticals, AstraZeneca, GI Dynamics, Guangzhou Zhongyi Pharmaceutical, Roche and Sanofi Avantis; and receiving grants for clinical study support from Amylin Pharmaceuticals, AstraZeneca, Hospira, Merck, Novo Nordisk, Pfizer and Sanofi-Aventis. Please see the study for all other authors’ relevant financial disclosures.
January 20, 2022
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Many US adults fail to achieve sustainable control over high BP

Perspective from Matthew Solomon, MD, PhD
Perspective from Eugene Yang, MD, FACC
Perspective from Seth Shay Martin, MD, MHS
Disclosures: Paul reports being an employee of AstraZeneca; acting as a consultant or speaker for Amylin Pharmaceuticals, AstraZeneca, GI Dynamics, Guangzhou Zhongyi Pharmaceutical, Roche and Sanofi Avantis; and receiving grants for clinical study support from Amylin Pharmaceuticals, AstraZeneca, Hospira, Merck, Novo Nordisk, Pfizer and Sanofi-Aventis. Please see the study for all other authors’ relevant financial disclosures.
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Only 30% to 50% of U.S. adults achieved sustainable BP control over 18 months after BP-lowering drug initiation, according to results of an electronic health record-based longitudinal cohort study.

Moreover, researchers said they found no evidence of improvement in BP control over the last decade.

An infographic with a quote that reads: Our finding is not surprising, yet we would like to emphasize that urgent attention from public authorities is needed to reverse this trend. The source of the quote is: Sanjoy Ketan Paul, PhD, MS.

“Unlike other studies, we were looking into sustainable BP control over 18 months post antihypertensive drug initiation,” Sanjoy Ketan Paul, PhD, MS, a professor of clinical epidemiology and biostatistics at the University of Melbourne in Australia, told Healio. “We are not aware of any U.S. study that holistically evaluated the BP control longitudinally over at least 18 months of follow-up from the time of antihypertensive therapy initiation at population level, with extensive consideration of multimorbidity, including cardiovascular diseases.”

Paul and colleagues analyzed the EHRs of 1,036,775 nationally representative adults who started and continued receiving BP-lowering drugs for at least 18 months from 2006 to 2018. At baseline, the mean age of the participants was 60 years; 45% were men; and 72% were white.

According to the findings, published in the American Journal of Preventive Medicine, the prevalence of diabetes and depression at the start of BP-lowering therapy consistently increased during the study period across all age groups, particularly among adults aged 18 to 49 years. In contrast, the prevalence of CVD was stable.

The adjusted probabilities of achieving sustainable systolic BP control were 0.62 (95% CI, 0.61-0.63) for adults aged 18 to 39 years, 0.55 (95% CI, 0.55-0.56) for those aged 40 to 49 years, 0.5 (95% CI, 0.49-0.5) for those aged 50 to 59 years, 0.43 (95% CI, 0.42-0.43) for those aged 60 to 69 years and 0.37 (95% CI, 0.37-0.38) for those aged 70 to 80 years.

Paul and colleagues also reported that at baseline or during the mean follow-up period of 4.7 years, 21% of participants had diabetes without CVD, 15% had CVD without diabetes and 10% had CVD and diabetes. These groups had, respectively, 48% (95% CI, 47-48), 31% (95% CI, 30-32) and 29% (95% CI, 27-29) adjusted probability of achieving sustainable systolic BP control compared with 52% (95% CI, 51-53) among those without these conditions (P < .01). Also, the adults who had microvascular diseases (including chronic kidney disease) had a 5% lower probability of achieving sustainable systolic BP control compared with adults who did not have one of those conditions (43% vs. 48%; P < .01).

In addition, 27% of the overall cohort had depression at baseline or during the follow-up period. The adults with depression had a 17% (OR = 1.15; 95% CI, 1.15-1.18) higher probability of sustainable systolic BP control compared with those without depression (likelihood of sustainable systolic BP control = 49% vs. 45%, P < .01). Separate analyses stratified by CVD and diabetes status, age and sex revealed similarly significantly better systolic BP control among adults with depression than those without depression (95% CI, OR range = 1.09-1.25).

“Unfortunately, our finding is not surprising, yet we would like to emphasize that urgent attention from public authorities is needed to reverse this trend,” Paul, who is also a member of the oncology business unit at AstraZeneca’s office in Luton, Australia, said.

According to Paul, there could be several explanations for the findings.

Adherence to medications in chronic diseases is a big issue globally,” he said. “Also, delayed diagnosis, disparities in proactive screening and treatment play a significant role, apart from differences in socio-economic status and lifestyle. There is also the issue of treatment inertia, that is delay in therapy initiation and therapy intensification when needed.”

There could be several ways to increase the number of U.S. adults who bring their high BP under control, Paul continued.

“Early diagnosis is important,” he said. “Also, serious lifestyle modifications such as stress reduction, diet and exercise must be addressed.”