The Elusiveness of Population-Wide High Blood Pressure Control

Abstract

High blood pressure (hypertension) is a leading risk factor for cardiovascular disease. It is highly prevalent in the US general population, especially in those who are old, African American, or socially disadvantaged. Prevalence is also high and increasing worldwide. Awareness, treatment, and control of hypertension have improved over time, but there is still considerable room for improvement. The optimal solution to this health challenge varies by country. Several nonpharmacologic and pharmacologic interventions are well proven as effective means to prevent hypertension and improve control rates in those with established hypertension. Better prevention and control of hypertension will yield substantial general population health benefits and remain high priorities in public health.

Research Needs to Improve Hypertension Treatment and Control in African Americans

“…3, 4 The corresponding prevalence estimate for African Americans is about 40%, and has also remained reasonably stable.…”

“…4 The lower prevalence of BP control is present despite use of more BP lowering medications, including thiazide diuretics. 15 This contrasts with clinical trial experience, where differences in BP control rates by race/ethnicity are modest or absent, particularly during chlorthalidone-based treatment.…”

Risk Factors for Low Pharmacy Refill Adherence Among Older Hypertensive Men and Women by Race

“…1,5,9,10 A higher prevalence of hypertension and uncontrolled blood pressure has been reported among older women compared to older men, and among blacks compared to whites. 1,2,11,12 Race differences in antihypertensive medication adherence mirror those for blood pressure control – antihypertensive medication adherence and blood pressure control are lower among blacks compared with whites. 13 Studies reporting sex differences in pharmacy refill adherence among men and women are less consistent: some studies report similar prevalence of low pharmacy refill adherence in older men and women, 5,14 while others report higher prevalence of low pharmacy refill adherence among older women compared to men.…”

Effectiveness of Chlorthalidone Plus Amiloride for the Prevention of Hypertension: The PREVER‐Prevention Randomized Clinical Trial

“…Given the low absolute risk of a clinical CVD outcome in adults with uncomplicated prehypertension, an event‐based trial of antihypertensive treatment in this setting would require a prohibitively large sample size to detect an intervention benefit. Prevention of incident hypertension has already been demonstrated with nonpharmacological and drug treatments in patients with prehypertension; however, long‐term maintenance of nonpharmacological interventions is difficult . The 2 drug‐treatment trials had design limitations, studied only patients at the upper limit of prehypertension, and failed to study the effect of treatment on target organ damage.…”