Uncontrolled hypertension common in adults despite access to health care

About half of the patients internist Yul Ejnes, MD, sees at his Cranston, R.I., practice on an average day have been diagnosed with hypertension or are being monitored for the condition.

He doesn’t typically diagnose the chronic disease on the first visit because there are various causes, such as anxiety, for temporary elevated blood pressure levels. But getting patients to return for a follow-up to take another blood pressure measurement can be challenging.

“For the most part, hypertension is completely silent. & Most patients don’t feel anything,” said Dr. Ejnes, past chair of the Board of Regents of the American College of Physicians. “Oftentimes, there’s a recommendation to come back in a few weeks, and the patient may not adhere to that recommendation” because he or she doesn’t feel sick.

The result is that physicians are not always able to diagnose hypertension among their patients. If a doctor does identify the disease, properly managing the condition can be difficult due to patients’ reluctance to keep scheduled appointments when they feel good, health professionals say.

Getting patients into the office for blood pressure-related visits is a widespread problem, doctors say. It could be contributing to the significant number of adults who do not have their hypertension under control, despite having a regular source of health care, doctors say.

Data show that 66.9 million Americans have hypertension, and 53.5% of them don’t have the condition under control. Among those with uncontrolled hypertension, 89.4% report a usual source of medical care and 85.2% have health insurance, according to a study in the Sept. 7 issue of the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report.

“The result of high blood pressure is about $131 billion a year in health care costs, and & [it] contributes to about 1,000 deaths per day,” said CDC Director Thomas R. Frieden, MD, MPH. “We have to roll up our sleeves and make blood pressure control a priority every day, with every patient, at every doctor’s visit.”

Improving blood pressure control

Hypertension is a major risk factor for cardiovascular disease and stroke, which are among the leading causes of death in the U.S., the CDC said. The risk of cardiovascular disease and stroke increases for the estimated 13.6% of adults who have stage 2 hypertension, the study said.

The Million Hearts initiative, which is being led by the CDC and other organizations, aims to prevent 1 million heart attacks and strokes by 2017. A key component of meeting that goal is controlling blood pressure.

To help improve hypertension control, the MMWR study recommends that health professionals consider implementing team-based care. Such care promotes improved communication with patients and other health professionals and adherence to evidence-based guidelines such as blood pressure guidelines by the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure.

Lead study author Amy L. Valderrama, PhD, RN, said using electronic health records can help physicians identify patients with hypertension by alerting them to consecutive elevated blood pressure readings.

The staff at Dr. Ejnes’ office follows up with patients who cancel or miss scheduled appointments and tries to reschedule the visits to ensure patients with hypertension receive appropriate care.

“There are many opportunities for people with high blood pressure to gain control,” said Valderrama, an epidemiologist in the CDC’s Division for Heart Disease and Stroke Prevention. “Doctors, nurses, other health care providers and their patients must pay regular and frequent attention to controlling” hypertension.

The MMWR study examined data on 20,811 adults 18 and older who participated in the National Health and Nutrition Examination Survey between 2003 and 2010. Pregnant women were excluded from the analysis.

Participants were considered aware of their condition if they said a health professional told them they had hypertension. Individuals were classified as being treated for the disease if they ever were prescribed medication to treat hypertension and if they were taking drugs to lower their blood pressure.

Researchers found that among those with uncontrolled hypertension, 44.8% were aware that they had the condition and were receiving medical treatment for it.

“Controlling blood pressure is not easy,” Dr. Frieden said. “It means taking medications, often multiple medications, every day, usually for the rest of your life, and ensuring that patients get support and follow-up. & What’s encouraging is that there are systems around the country that have done such a good job at this. It tells us that it’s possible.”