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AHA: Mortality from uncontrolled BP rises; CVD leading cause of death in US
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The rate of deaths caused by high BP increased by 10.5% from 2005 to 2015, and the actual number of deaths attributable to high BP increased by 37.5%, according to the American Heart Association’s 2018 Heart Disease and Stroke Statistics Update.
According to the report, hypertension affected nearly one-third of the world’s adult population in 2010.
“With the aging of the population and increased life expectancy, the prevalence of high blood pressure is expected to continue to increase,” Paul Muntner, PhD, MHS, FAHA, professor and vice chair in the department of epidemiology at the University of Alabama at Birmingham and co-vice chair of the writing group, said in a press release.
CVD deaths
Emelia J. Benjamin, MD, SCM, FAHA, professor of medicine in the section of cardiovascular medicine at Boston University School of Medicine and chair of the update’s writing group, and colleagues wrote that the leading cause of death was heart disease, although mortality from CVD declined from 1979 to 2015. The leading causes of death from CVD in the United States were CHD (43.8%), stroke (16.8%), high BP (9.4%), HF (9%) diseases affecting the arteries (3.1%) and other CVDs (17.9%). More than 130 million U.S. adults will have some form of CVD by 2035, according to the update.
An estimated 720,000 Americans will have a new coronary event in 2018, the authors wrote. Mortality caused by CHD decreased by 34.4% from 2005 to 2015 and is predicted to decline by 27% by 2030, although racial disparities are also projected to continue.
As the population ages, HF prevalence continues to increase, and CHD continues to be a major risk factor for HF. Between 2011 and 2014, an estimated 6.5 million American adults older than 20 years had HF, which increased from the 5.7 million American adults between 2009 and 2012.
According to the researchers, the prevalence of obesity in adults increased from 34.9% in 2011-2012 to 37.7% in 2013-2014. This also increased in children, from 16.9% in 2011-2012 to 17.2% in 2013-2014.
Controllable risk factors
An estimated 11.9% of U.S. adults have serum total cholesterol levels of at least 240 mg/dL. Nearly half of U.S. adults aged at least 40 years (48.6%) are eligible for statin therapy, but its use remained unchanged.
Although there has been a constant decline in tobacco use, 15.1% of adults and 4.2% of adolescents in the U.S. were current smokers in 2015. The leading cause of preventable death in the U.S. and worldwide is tobacco use. Electronic cigarette use has been sharply increasing in adolescents in the past 5 years.
Only 21.5% of U.S. adults in 2015 achieved adequate muscle-strengthening and leisure-time aerobic activities recommended by guidelines. Community strategies and interventions focusing on physical activity reduced medical spending.
Poor dietary habits were the cause of 45.5% of U.S. deaths caused by stroke, heart disease and diabetes. The main dietary factors of poor habits included low consumption of seafood omega-3 fats, nuts, seeds, fruits and vegetables, and high intakes of sodium, processed meats and sugar-sweetened beverages. – by Darlene Dobkowski
Disclosures: Muntner reports he receives grant support from and is a consultant/advisory board member for Amgen. Benjamin reports no relevant financial disclosures. Please see the report for all other authors’ relevant financial disclosures.
Perspective
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Parag H. Joshi, MD, MHS
In general, this study highlights that we still have a lot of opportunity to prevent heart disease, still the No. 1 killer of Americans and one of the biggest contributors to overall health care costs.
The risk factor profile that contributes to heart disease is slowly changing with less smoking but more obesity-related risk factors.
BP remains an easily modifiable risk factor, but we need to do a better job of tackling it early. We know that levels above 115 mm Hg systolic/75 mm Hg diastolic are associated with increasing risk.
The change in the definition of what is considered high BP with the newest guidelines released in 2017 are a recognition of this fact.
By changing the criteria for what is now considered hypertension to lower BPs that were previously considered OK, we are drawing focus to addressing the problem before it gets worse.
This will hopefully lead to earlier initiation of lifestyle modifications to reduce the overall contribution of elevated BP to heart disease.
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