There is good news and bad news about hypertension and blood pressure control in the US. The good news is that although the prevalence of hypertension is high, it can be controlled with medication, and for years rates of blood pressure control were on the rise. The bad news is that a study has confirmed what many have suspected, that the percentage of US adults with hypertension who have their blood pressure under control is declining.
for surveypublished in the magazine hypertension, The researchers analyzed data from the National Health and Nutrition Examination Survey (NHANES) over three four-year periods: 2009-2012, 2013-2016, and 2017-2020.
NHANES is a cross-sectional survey of the US civilian, non-institutionalized population that combines interviews and physical examinations. It is conducted by the National Center for Health Statistics, a unit of the Centers for Disease Control and Prevention.
NHANES data show that the proportion of US adults with hypertension who had their BP controlled increased significantly, rising from 31.8% in 1999 to 2000 to 53.8% in 2013–2014.
“However, between 2013 and 2014 and 2017 to 2018, the improvement in blood pressure control reversed,” write the authors, who include Gregory Wozniak, PhD, vice president of health outcomes analytics at the AMA.
Hypertension was defined as systolic blood pressure of 140 mm Hg or higher or diastolic blood pressure of 90 mm Hg or higher and use of antihypertensive drugs. In those with hypertension, blood pressure control was defined as systolic pressure less than 140 mmHg and diastolic pressure less than 90 mmHg.
The percentage of US adults with hypertension who had their blood pressure controlled fell steadily, from 52.8% in 2009-2012 to 51.3% in 2013-2016 and 48.2% in 2017-2020. Similarly, blood pressure control among those taking antihypertensive medication fell from 69.9% in 2009-2012 to 67.7% in 2017-2020.
Among all US adults with hypertension taking antihypertensive medications, a decline in blood pressure control over the study period occurred in those 75 years or older, women, and nonhypertensive black adults.
discover four reasons why blood pressure control has declined among American adults.
Meanwhile, the age-specific prevalence of hypertension increased in the three consecutive periods, from 31.5% in 2009–2012 to 32% in 2013–2017 and 32.9% in 2017–2020. It also rose among non-Hispanic Asian adults, from 27.0% in 2011-2012—when data were first available for this group—to 33.5% in 2017-2020, and among Hispanic adults, from 29.4% in 2009-2012 to 33.2% in 2017-2020.
In 2020, the US surgeon general issued a call to action to control hypertension. In addition to identifying goals for improving BP control rates in general, it recommends focus areas to promote health equity.
“The call to action recognized the disparities in hypertension prevalence and blood pressure control among different segments of the American population and emphasized the need to address health disparities and disparities so that all members of society can reach their full potential health,” the authors write. . “Data from the current study suggest that these goals are growing in importance.”
The AMA has developed online tools and resources designed using the latest evidence-based information to support physicians to help manage their patients’ high blood pressure. These resources are available to all physicians and health systems through the AMA MAP BP™, an evidence-based quality improvement program that provides a clear path to significant and sustainable improvements in BP control.
AMA MAP BP features robust data and metrics—including through a dashboard that provides monthly reports and data tracking on process and outcome measures. Additionally, AMA experts provide planning and support during program setup and implementation, such as assistance with assessing practice site readiness, training clinical teams, and creating kick-off event presentations.
The resources provided by the AMA as part of the AMA MAP BP are provided at no cost. Contact the AMA to learn how your organization can get started.