No improvement in CV death for adults with hypertension in recent years
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Key takeaways:
- Despite improved hypertension control, parallel decline in CVD mortality in Americans with high blood pressure stalled.
- No significant change in CVD death in this population has been observed since 2010.
After decades of decline in CVD deaths among patients with hypertension, there has been no significant change since the first decade of the 2000s, according to a study published in Hypertension.
“In 1972, the National Heart, Lung, and Blood Institute established the National High Blood Pressure Education Program with the goal of reducing death and disability from hypertension. Following the initiation and implementation of the National High Blood Pressure Education Program, hypertension awareness and the proportion of U.S. adults with hypertension taking antihypertensive medication and with controlled BP increased substantially,” Eunhee Choi, PhD, assistant professor of pathology and cell biology at the Columbia Hypertension Laboratory at Columbia University Irving Medical Center, and colleagues wrote. “In the current study, we evaluated changes in all-cause, CVD and non-CVD mortality rates among four nationally representative samples of U.S. adults with hypertension from 1988 through 2016 from the National Health and Nutrition Examination Survey with linked mortality data through 2019.”
For this study, Choi and colleagues evaluated trends in all-cause death, CVD death and non-CVD death in a cohort of 20,927 individuals with hypertension.
Hypertension was defined as systolic BP 140 mm Hg or more, diastolic BP 90 mm Hg or more or use of antihypertensive medication.
Participants with up to three BP measurements at one of four time points were included: 1988 to 1994, 1999 to 2004, 2005 to 2010 and 2011 to 2016.
The 1988 to 1994 time point was used as a reference point for mortality comparisons.
Among U.S. adults with hypertension, the average systolic and diastolic BP decreased from 143.9 mm Hg and 80.3 mm Hg, respectively, in the 1988 to 1994 period to 136.4 mm Hg and 73.9 mm Hg, respectively, in the 2005 to 2010 period. Systolic and diastolic BP for adults with hypertension slightly decreased further in the 2011 to 2016 period to 136.2 mm Hg and 73.5 mm Hg, respectively.
In addition, the percentage of patients taking antihypertensive medication increased from 53.2% in the 1988 to 1994 period to 74.7% in the 2011 to 2016 period, according to the study.
After adjusting for age, sex and race/ethnicity, the risk for all-cause mortality was slightly lower during all other periods compared with the 1988 to 1994 cohort, but the trend was not significant (P for trend = .123).
Compared with the 1988 to 1994 period, the adjusted risk for CVD mortality was lower in the 1999 to 2004 period (adjusted HR = 0.74; 95% CI, 0.6-0.9), the 2005 to 2010 period (aHR = 0.61; 95% CI, 0.5-0.74) and the 2011 to 2016 period (aHR = 0.57; 95% CI, 0.44-0.74; P for trend < .001), but there was little decline between 2005-2010 and 2011-2016 (P = .661).
Additionally, the researchers reported no significant change in non-CVD death over the study period (P for trend = .145).
“These study findings suggest that the decline in CVD mortality among U.S. adults with hypertension has stalled since 2005 to 2010,” the researchers wrote. “There should be renewed focus on improving blood pressure control among U.S. adults with hypertension and preventing hypertension among those without it. There are opportunities to further reduce all-cause and CVD mortality among U.S. adults with hypertension by treating other CVD risk factors.”
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