Regular physician visits linked to controlled hypertension

Patients who visit their physician at least two times per year, have health insurance and are receiving cholesterol treatment are more likely to have controlled hypertension compared with patients with less frequent physician visits, no insurance and no cholesterol treatment, according to a new analysis.

Researchers analyzed time trends in National Health and Nutrition Examination Surveys from 1999 to 2012 to determine progress made toward the Healthy People 2020 goals of reducing hypertension prevalence to 26.9%, increasing hypertension treatment to 69.5% and increasing hypertension control to 61.2% among American adults. Brent M. Egan, MD, professor of medicine at the University of South Carolina School of Medicine and senior medical director of Care Coordination Institute, Greenville, S.C., and colleagues studied NHANES participants aged 18 years and older with at least one recorded BP measurement. Of the 37,005 participants studied, 12,262 had hypertension.

Brent M. Egan

Prevalence unchanged

From 1999-2000 to 2011-2012, the prevalence of hypertension was unchanged (30.1% vs. 30.8%; P=.32). The researchers recorded increases, however, in hypertension treatment (59.8% vs. 74.7%; P<.001) and the proportion of treated adults with controlled hypertension (53.3% vs. 68.9%; P=.0015).

Hypertension control, defined as systolic BP <140 mm Hg/diastolic BP <90 mm Hg, rose every 2 years from 1999-2000 to 2009-2010 (32.2% vs. 53.8%; P<.001), but declined to 51.2% in 2011-2012, according to the results.

The researchers identified several significant modifiable factors including an independent association between prevalent hypertension and increasing BMI (OR=1.44); an independent association between untreated hypertension and lack of health insurance (OR=1.68) and fewer than two physician visits per year (OR=4.24); and an independent association between controlled hypertension and health insurance (OR=1.69), fewer than two physician visits per year (OR=3.23) and cholesterol treatment (OR=1.9).

Link between obesity, hypertension control

Obesity was a significant factor in controlled hypertension (OR=1.11), likely because “doctors recognize the need to control risk factors and may be quicker to give [people with obesity] [BP] medications,” Egan said in a press release.

“Given that prevalent hypertension stabilized at absolute levels 3% to 4% above the 2020 goal of 26.9%, new strategies or novel approaches are required,” Egan and colleagues wrote. “The Healthy People 2020 goal of controlling hypertension in 61.2% of all adults is challenging given control at 51.2% in NHANES 2011-2012. Hypertension begins with awareness. Insurance increases health care utilization and risk factor awareness. Growth of accountable care organizations should also raise hypertension screening and awareness. To foster progress, our analysis is consistent with previous data that obesity prevention and treatment could reduce incident and prevalent hypertension.”

For more information:

Egan BM. Circulation. 2014;doi:10.1161/CIRCULATIONAHA.114.010676.

Disclosure: The study was funded by the NIH, the US Army, the CDC and the state of South Carolina. Egan reports consulting for Blue Cross Blue Shield South Carolina, Daiichi Sankyo, Medtronic and Novartis and research support from Daiichi Sankyo, Medtronic, Novartis and Takeda.