High blood pressure awareness and control worsening in the U.S.

High blood pressure is a risk factor for cardiovascular diseases, such as heart disease and stroke. Understanding the condition and knowing how to control it is crucial to prevent these life-threatening conditions.

In a new study, which was funded by the National Heart, Lung, and Blood Institute (NHLBI), a team of scientists found that after 15 years on an upward trend, the awareness about high blood pressure and how to treat it among Americans has declined.

Published in the journal JAMA, the study finds that a growing percentage of adults in the United States have uncontrolled high blood pressure, which is known as the “silent killer” and a significant risk factor for severe illness from the coronavirus disease (COVID-19).

Silent killer

With the coronavirus pandemic actively spreading across the globe, infecting more than 27 million people, those with hypertension need to control their blood pressure more than ever as elevated blood pressure has been linked to severe COVID-19, which may cause death.

Also, the U.S. Centers for Disease Control and Prevention (CDC) reports that nearly half of adults in the country or 108 million adults have hypertension, which is defined as systolic blood pressure more than 140 mmHg or a diastolic blood pressure more than 90 mmHg or the use of antihypertensive drugs. Only 1 in four adults or 24 percent with hypertension have their condition under control.

Also, high blood pressure was a primary or contributing cause of death for more than 490,000 people in the country in 2018 alone.

Declining awareness and control

The study authors said that the declining trend could make longstanding efforts to combat heart disease and stroke, the leading causes of death across the U.S. and the globe, even more difficult.

“Reversing this decline is important because we don’t want to lose public health achievements built over prior decades,” Dr. Lawrence Fine, chief of the Clinical Applications and Prevention Branch at NHLBI and a study co-author, said.

“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,” he added.

The researchers looked at more than 18,000 adults in the U.S. who are more than 18 years old who have hypertension. The team surveyed the participants, which are representative of U.S. adults between 1999 and 2000, and 2017 and 2018.

The data in the 1999-2000 period was obtained from the National Health and Nutrition Examination Survey (NHANES), which exhibited the 20-year trends in high blood pressure awareness, treatment, and blood pressure control.

At the start of the survey, the researchers measured the blood pressure of the participants three times, and then the average was taken. The participants also completed a survey asking them if they know they had high blood pressure, and if they are currently taking prescribed medications.

The researchers revealed that between 1999 and 2000, just 70 percent of the participants are aware of their hypertension, and it increased steadily to 85 percent from 2013 to 2014. However, the percentage of those who are aware declined to 77 percent between 2017 and 2018.

Of the participants who are aware of their condition, the number of those who took antihypertensives remained consistent, which is 85 percent in the period 1999-2000, 89 percent in 2013-2014, and 88 percent in 2017-2018.

“In a series of cross-sectional surveys weighted to be representative of the adult U.S. population, the prevalence of controlled B.P. increased between 1999-2000 and 2007-2008, did not significantly change from 2007-2008 through 2013-2014, and then decreased after 2013-2014,” the authors wrote in the study.

Blood pressure control

Further study findings show that of all the adults with hypertension, the number who were able to control the condition increased from 32 percent in the 1999-2000 period to 54 percent between 2013 and 2014. However, the number declined to 44 percent between 2017 and 2018. The number of people taking blood pressure drugs increased from 53 percent in 1999-2000 to 72 percent in 2013-2014, then declined to 65 percent in 2017-2018.

The researchers said that the study findings highlight the importance of continuity of care, including having regular doctor visits. Blood pressure monitoring is also vital for patients to be aware of their readings, as well as informing them about the importance of taking their medications.

From 2015 to 2018, older adults who are more than 60 years old, as well as Black Americans, were less likely than adults ages 18 to 44 years old, and white Americans to have controlled blood pressure. However, those with health insurance were more likely to have their blood pressure under control compared with those who have no health insurance.

“Educating patients and providers on blood pressure goals, adding effective blood pressure medications when lifestyle changes aren’t enough, and reducing barriers to achieving 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,” Dr. Paul Muntner, the lead study author and professor and Associate Dean for Research in the School of Public Health at the University of Alabama at Birmingham, recommended.

Journal reference:
Angela Betsaida B. Laguipo

Written by

Angela Betsaida B. Laguipo

Angela is a nurse by profession and a writer by heart. She graduated with honors (Cum Laude) for her Bachelor of Nursing degree at the University of Baguio, Philippines. She is currently completing her Master's Degree where she specialized in Maternal and Child Nursing and worked as a clinical instructor and educator in the School of Nursing at the University of Baguio.


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