Hypertension is Not as Well Recognized and Well Controlled as One Might Think

Blood pressure is easily measured. Everyone is told by their physician and public health education materials that the high blood pressure of hypertension is a bad thing. Lifestyle change and low cost drugs can reduce blood pressure to normal levels in a majority of patients. So is hypertension a medical condition that is under control in the population at large? Apparently not. One can produce the therapies and propagate the information, but even so only a fraction of those who might benefit are in fact acting to eliminate the contributions made by hypertension to mortality and late life decline.

Uncontrolled hypertension is a major risk factor for stroke and myocardial infarction. Health providers should be aware that uncontrolled hypertension is one of the most common, serious and increasing conditions in their patients. Nationally, adults over the age of 18 include 249.2 million people of which 119.9 have hypertension. Myocardial infarction accounts for 25% of all deaths and stroke about 16.5%.

Hypertension has long been deemed "the silent killer" as most patients affected were unaware of their condition until its first presenting symptom was the myocardial infarction or stroke. Sudden cardiac death accounts for 50% of deaths from cardiovascular disease and is the first symptomatic event in ≥25% of cases. In addition, for 76% of stroke patients, the initial presenting symptom is the stroke itself.

Control of hypertension is effective and, at least in theory, is straightforward. Before the Hypertension Detection and Follow Up Program only about 50% of patients were aware of their hypertension, and of those, only 50% were actively treated. Of that group, only 50% received effective treatment. Thus, 1/8 of all patients were effectively treated. Today these figures are 54% aware of their hypertension, 40% actively treated, and 21% adequately controlled, respectively.

Link: https://doi.org/10.1016/j.amjmed.2024.07.005