The treatment of unmanageable Hypertension in Adults at United States, during 2003 to 2010

The data for this study was taken from the National Health and Nutrition Examination Survey or NHANES to observe and evaluate the treatment of hypertension that is uncontrollable in the adults of US nation, who are suffering from hypertension. Hypertension plays an important role in creating the risk for cardiovascular disease. Hypertension is also known to be the cause of morbidity and mortality. This study also focuses on learning about the awareness of the individuals with uncontrollable hypertension. The current study emphasizes on three groups. The first group constitutes those who are not aware of the hypertension. The second group constitutes those who are aware of their hypertension and not treated with drugs. The third group constitutes those who are aware of their hypertension and are treated with drugs in spite of which they have unmanageable hypertension.

The awareness and the treatment for hypertension that was unmanageable in adults was evaluated with the help of the data that is obtained from NHANES 2003-2010 and which is CDC analyzed. Uncontrolled hypertension is defined as the average systolic blood pressure greater than or equal to 140mmHg and the average diastolic blood pressure greater than or equal to 90 mmHg.

Results: According to the results of this study, the predominance of hypertension in the adults of United States and who are at the age of greater than or equal to 18 years in the period between 2003 and 2010 was 30.4 percent (66.9million).  Among all those people who had hypertension, 35.8 million or nearing about 53.5 percent was not able to control the hypertension. Among the population with uncontrolled hypertension, 14.1million or 39.4 percent were estimated to be not aware of the hypertension they had. About 5.7million or 15.8 percent were estimated to be aware of their hypertension and were not able to receive treatment. Nearly 16milion or 44.8 percent were treated with the hypertension drugs as well as were found to be aware of the disease they have. Among the 35.8 millions of US adults with unmanageable hypertension, 85.2 percent were found to possess health insurance while 89.4 percent were found to undergo common form of health care.

Conclusion: Even slight increase in blood pressure enhances the risk of cardiovascular disease and mortality. The mortality due to ischemic heart disease and heart stroke were increased twice for every 20mmHg increase in systolic blood pressure (from 115mmHg) and for every 10mmHg increase in diastolic blood pressure (75mmHg).

Nearly thirty percent of unmanageable hypertension patients who are aware that they have hypertension and are treated with medications were known to have stage-2 hypertension. The stage-2 hypertension has systolic pressure greater than or equal to 160mmHg and the diastolic pressure greater than or equal to 100mmHg. These people will have higher risk for confrontational cardiovascular problems with increased blood pressure. To improve control on hypertension, the health care systems must focus much on the blood pressure. The health care system includes health care professionals as well. There are certain strategies for control of hypertension that are clinical based, which include utilizing practice guidelines, health care delivery models that are innovative like medical homes that are patient centered, team based care and medications that promote usage of the drug. The team based care involves advanced communication of patients and other health care providers. The team care also includes following the guidelines like blood pressure guidelines given by the National Committee on Evaluation, Prevention, Detection, treatment of High Blood Pressure. People can also bring hypertension under control to a large extent by following drug adherence, taking low sodium diet and evaluating their own blood pressure.

This report is said to have three limitations. The survey was done by NHANES on the non-institutionalized United States population. The report does not include the military personnel as well as people living in nursing homes and other places. Therefore, the investigations might have underestimated the prevalence of hypertension while the old residents of nursing home might experience higher age-associated hypertension. Overestimation of hypertension prevalence might occur if the military people are excluded in the study. This is because military people are young, physically fit and possess low prevalence of hypertension. Secondly, the data that is self-reported regarding the awareness and medication intake for hypertension might have a bias. Finally, the report in this study focused on the hypertension treatment for those who have used the medication and not on people who reduced their BP through dietary approach. The above findings can help targeting populations and in improving the interventions for control of hypertension. The control of hypertension can be improved and it needs a large patient effort and large contribution from health care providers.

Reference: “Vital Signs: Awareness and Treatment of Uncontrolled Hypertension Among Adults – United States, 2003-2010,” Morbidity and Mortality Weekly Report, Sept. 7 (2012); 61(35): 703-709 published at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6135a3.htm