A recent report published by the Centers for Disease Control and Prevention provides data that shows about 47 percent of Americans who have been diagnosed with high blood pressure are not adequately controlling it. Though concerning, it’s an improvement from data published in 1999 that revealed about 68 percent of Americans had high blood pressure that was not controlled.
Overall, about 29 percent of adults in the United States have hypertension. That would mean roughly 76 million Americans over the age of 20 have high blood pressure. Without being a mathematician roughly half of that number is a very high number. “I don’t think we have enough positive information to be cheering,” stated Patrick O’Gara, MD, executive medical director of the Carl J. and Ruth Shapiro Cardiovascular Center at Brigham and Women’s Hospital in Boston. “Although the trend is positive, the magnitude of the problem is self-evident. We have a lot of work to do.”
The reason why this is problematic is that high blood pressure directly increases cardiovascular risk. Hypertension or high blood pressure is the most common reason for nonpregnant adult visits to clinicians. There are several possible reasons that can account for why blood pressure remains such a difficult problem to treat. There may be poor access to healthcare and medications, lack of adherence to medications, especially considering most people with high blood pressure are usually asymptomatic and immediate benefits of taking medications may not be so obvious. We often do not fear what we cannot see, therefore high blood pressure is aptly named “the silent killer.” The other reason could be that clinicians may not be as aggressive about adjusting medications when patients are found to be hypertensive. All these reasons will likely continue to contribute to making hypertension the most common risk factor for heart attack and stroke.
According to the most recent definitions for hypertension anything above 140/90 (the systolic and diastolic blood pressure respectively) is considered high blood pressure. Normal is below 120/80 and anything in between is considered pre-hypertension. There has been considerable controversy surrounding optimal blood pressure levels. The recent landmark SPRINT trial revealed that blood pressure readings below 120/80 were the most beneficial in preventing serious adverse events such as heart attacks, strokes and death. In fact, the data from the study was so compelling that they cut the trial short to discuss the benefits of aiming for tighter blood pressure control.
High blood pressure is something that can be controlled, for the most part, making it a modifiable risk factor for developing cardiovascular disease (CVD). It is more prevalent than other modifiable risk factors such as high cholesterol, smoking or diabetes. With adequate blood pressure surveillance (frequent monitoring at home), and treatment it would be very possible to significantly reduce rates of heart attacks, strokes.
The federal Healthy People 2020 goal is to have the percentage of Americans with uncontrolled hypertension below 40. While there may have been some confusion before, we are no powered with the knowledge that lower is better. I feel that greater effort should be put forth in making this a national priority and if an aggressive campaign is launched there is a real possibility we can meet and or exceed that goal.