Blood Pressure Control Has Improved Markedly

Gains in blood pressure control are primarily due to increased use of multiple antihypertensive agents, but hypertension still takes a great financial and health quality toll.

Blood pressure (BP) control among adults with hypertension has improved greatly over the last decade, and much of the improvement is due to increased use of multiple antihypertensive agents, according to a study published in the October 23, 2012, edition of Circulation.

The researchers analyzed data on 9320 American adults with hypertension from the 2001 through 2010 National Health and Nutrition Examination Surveys (NHANES), a nationally representative cross-sectional sample of the US population. The results showed that 47.2% of all people with hypertension had their BP under control in 2009-2010, up from 28.7% in 2001-2002. Among those taking medication for their hypertension, 60.3% had their BP under control in 2009-2010, up from 44.6% in 2001-2002.

Over the same period, the prevalence of antihypertensive medication use by those with hypertension increased from 63.5% to 77.3%, and use of multiple antihypertensive agents increased from 36.8% to 47.7%. Compared with monotherapy, single-pill combination therapy and multiple-pill combination therapy were associated with 55% and 26% increased likelihoods of achieving BP control, respectively. BP control targets were defined as under 130/80 mm Hg for those with diabetes or chronic kidney disease and under 140/90 mm Hg for all others.

Between 2001-2002 and 2009-2010, use of thiazide diuretics increased from 22.4% to 27.6% of patients with hypertension; use of beta-blockers increased from 20.3% to 31.9%; use of calcium channel blockers increased from 19.2% to 20.9%; use of angiotensin-converting enzyme (ACE) inhibitors increased from 25.5% to 33.3%; and use of angiotensin receptor blockers (ARBs) increased from 10.5% to 22.2%. In 2009-2010, the most commonly used antihypertensive medications were lisinopril (an ACE inhibitor), metoprolol (a beta-blocker) and hydrochlorothiazide (a thiazide diuretic).

Higher than average rates of uncontrolled BP despite treatment persisted among older patients, non-Hispanic blacks, those with diabetes, and those with chronic kidney disease. (In 2009-2010, more stringent BP goals of 130/80 mm Hg were met by 44.6% of hypertensive patients with diabetes and by 43.7% of hypertensive patients with chronic kidney disease; less stringent goals of under 140/90 mm Hg were met by 67.0% of those with diabetes and 61.7% of those with chronic kidney disease.)

Mexican-Americans were less likely to take antihypertensive medications and less likely to use multiple medications than non-Hispanic whites, a situation exacerbated by the fact that all Hispanics have a 49% higher rate of non-persistence with prescribed medication than other racial groups. Older patients were more likely to get antihypertensive medication but less likely to reach BP goals than younger patients. In addition, although there has been a consistent trend in which women have been more likely to receive antihypertensive medication but less likely to have controlled BP than men, in the most recent 3 NHANES cycles, BP control rates among treated patients have been very similar for men and women.

Despite the consistent progress in achieving BP control found in the study, a September 2012 Vital Signs report from the Centers for Disease Control and Prevention serves as a reminder that there is still a great deal of room for progress. The report notes that hypertension contributes to almost 1000 deaths per day and accounts for $131 billion in direct health care costs per year in the United States. To help improve BP control, the report recommends that health care providers be on the lookout for patients with uncontrolled BP, counsel patients to take their medication, and routinely evaluate whether patients should switch medications. In particular, it recommends use of once-a-day medication doses where possible to improve adherence.

Recent Pharmacy Times articles on the role of pharmacists in helping to improve BP control:

• Pharmacist Telemonitoring Improves Blood Pressure Management
• Pharmacist Monitoring Aids in Blood Pressure Control
• Pharmacists Should Seize Opportunity to Help Patients Control Blood Pressure