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Inadequate hypertension control linked to cardiovascular comorbidities
Although hypertension treatment rates were comparable with earlier studies, the rate of hypertension control showed no improvement.
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Cardiovascular comorbidities are making it difficult to control hypertension in the adult population, and the problem is highly prevalent.
Results of a study examining data from the National Health and Nutrition Examination Survey suggested that inadequate control of systolic hypertension was prevalent in nearly 75% of adults. The study results also revealed that those with cardiovascular comorbidities had the most difficult time controlling systolic hypertension. The results were published in the Archives of Internal Medicine.
A total of 4,646 participants met the study criteria for BP measurements and 31.4% (n=1,671) of the participants had hypertension. Cardiovascular comorbidities among the study population included CAD, stroke and congestive HF, as well as other comorbidities associated with CVD like chronic kidney disease, diabetes, metabolic syndrome and dyslipidemia.
Hypertension
The researchers reported that the presence of hypertension in participants with no CVD was 23.1%. By comparison, the prevalence of hypertension in participants with diabetes was 76.8%, chronic kidney disease, 81.8%; stroke, 69.5%; congestive HF, 71.4%; peripheral artery disease, 73.7%; CAD, 73%; and 76.9% in those with two or more CVD conditions. Although treatment rates among participants with these conditions were between 65.9% and 89.3%, the rates of hypertension control from that treatment were low, ranging from 34.9% to 61.2%. Participants with no diseases were on average closer to meeting BP goals than any group of participants with CVD or related conditions.
In particular, the findings were of concern for patients who had survived stroke. Although 89% of patients with stroke were treated for their hypertension, the researchers reported that only 34.9% of those patients had their BP controlled to an adequate level <140 mm Hg/90 mm Hg, and subsequently that there remained a one-in-six chance of these stroke survivors experiencing another stroke within five years. - by Eric Raible
It is actually stunning when one looks at this paper how miserable the control of BP still is. I was actually surprised to see that. I thought we were doing a little better than that. The most alarming finding is the table where you see the mean value of the distance that the average patient is from the goal BP. It is particularly tragic for patients who have had a stroke because stroke is the most devastating complication of hypertension. Neurologists are a bit reluctant to lower BP for stroke patients, and that is probably one of the reasons that we are doing so badly. Considering, though, that the recurrence rate of stroke is rather high and BP is the major determinate for another stroke, this is an alarming finding indeed.
— Franz H. Messerli, MD
For more information:
- Wong N, Lopez V, L’Italien G, et al. Inadequate control of hypertension in US adults with cardiovascular disease comorbidities in 2003-2004. Arch Intern Med. 2007;167:2431-2436.