Poor bill of health given for hypertension checkup on Healthy People 2020

With nearly five years left on the Healthy People 2020 goals for hypertension, researchers measured progress and found much wanting. Although key areas have improved, according to the study published online Oct. 20 in Circulation, prevalent hypertension remained well above the goal of 26.9 percent and hypertension control efforts plateaued well below the goal of 61.2 percent.

Brent M. Egan, MD, of the Greenville Health System in Greenville, S.C., and colleagues reviewed data collected between 1999 and 2012 as part of the National Health and Nutrition Examination Surveys (NHANES). They used NHANES data to determine the progress made toward Healthy People 2020 hypertension health goals in the U.S.

The hypertension goals for Healthy People 2020 include reductions in prevalent hypertension to 26.9 percent, treatment in 69.5 percent of all hypertensive adults and control in 61.2 percent of all hypertensive adults. Hypertension control was defined as blood pressure in these patients of less than 140/90 mmHg. The goals represent a 10 percent reduction over 2005 to 2008 numbers.

A bright point in the goals assessment was that 74.7 percent of hypertension patients were being treated, well above the mark. Despite this, overall hypertension care fell short: Prevalent hypertension hovered between 30.1 percent and 30.8 percent in 2011 and 2012, respectively, sitting 3 percent to 4 percent above goal. Control levels stayed stable after 2007, below 70 percent. However, Egan et al calculated that in order to reach those goals, 88.1 percent of treated patients would need to be successfully controlled.

Despite this, Americans should not admit defeat as yet. Egan et al noted many of the factors involved were still modifiable, including access and use of medical care, statin use, improved diet and reductions to body mass index.

They found risks for undiagnosed and untreated hypertension increased with body mass index and hypercholesterolemia and correlated with reduced access to regular healthcare. Patients who were black or Hispanic with little healthcare access had higher uncontrolled blood pressure than white counterparts, Egan et al noted. However, new guidelines on cholesterol, increased obesity prevention and treatment and improved insurance access and healthcare utilization would improve the hypertension outlook, Egan et al wrote.

In an editorial, Benjamin D. Sommers, MD, PhD, of the Harvard School of Public Health in Boston, wrote based on Egan et al’s findings, the Affordable Care Act should go a long way toward achieving those goals. Sommers noted the number of uninsured adults dropped between late 2013 and early 2014 by about 10 million, mostly among racial and ethnic minorities.

“Whether this coverage expansion in turn will lead to population-level improvements in blood pressure control or reduce the long-term incidence of hypertension remain critical and unanswered questions for the nation’s public health,” Sommers wrote.