Chart Carts

0 snapshots in My Collection

High Blood Pressure Awareness, Treatment, and Control

How many adults have their blood pressure tested? How many adults with high blood pressure lower it to a healthy level?

In 2003, most adults (90%) had their blood pressure measured within the prior two years and could recall whether the reading was high or low. Although almost two-thirds of adults with high blood pressure were taking blood pressure medication during 1999–2002, less than one-third had their blood pressure under control. Both measures improved by 6 percentage points from 1988–1994.

Slide For High Blood Pressure Awareness, Treatment, and Control
Slide For High Blood Pressure Awareness, Treatment, and Control


Why is this important?

  • About 31 percent of U.S. adults—65 million Americans—have high blood pressure (hypertension) or are being treated to control their blood pressure (Fields et al. 2004).
  • High blood pressure is a risk factor for heart attack, heart failure, stroke, and kidney disease. It contributes to 227,000 deaths each year, reduces life expectancy by about five years on average, and takes an economic toll of $64 billion in medical and societal costs (Franco et al. 2005; Thom et al. 2006).
  • High blood pressure can be controlled with lifestyle modifications (e.g., diet, exercise, weight reduction) and medication. Most patients with high blood pressure require multidrug therapy to reach the goals recommended by the National Blood Pressure Education Program (Chobanian et al. 2003).

Findings

  • Although most adults say that they are aware of their blood pressure status, almost one-third of those identified as having hypertension said that they had not been told by a health care professional that they had high blood pressure (data not shown).
  • More than one-third of U.S. adults with high blood pressure were not taking blood pressure medication to control their condition during 1999–2002, and more than two-thirds—46 million Americans—did not have their blood pressure under control. Both measures improved (by 6 percentage points) from 1988–1994 (Gu et al. 2006).
  • Women were more likely than men to be taking blood pressure medication and to achieve blood pressure control. The percentages of men taking blood pressure medication and achieving control increased by 10 percentage points from 1988–1994 to 1999–2002. These rates changed little among women during this time (Gu et al. 2006).

Implications

  • The quality gap in blood pressure treatment and control may be due, in part, to the reluctance of physicians to treat patients with mildly elevated blood pressure as aggressively as experts recommend (Hyman and Pavlik 2002).
  • Substantial improvement is needed to reach the Healthy People 2010 goal that 50 percent of hypertensive adults control their blood pressure (DHHS 2000). Achieving the level of control seen in the best-performing health plans (75%) could prevent 32,000 premature deaths and 28 million lost work days while saving $5.6 billion in medical costs and lost productivity (NCQA 2005).

Improvement Ideas and Resources

A review of quality-improvement studies found that many strategies were effective for improving hypertension care and outcomes (Walsh et al. 2005). Across all studies, attainment of target systolic pressure improved by 16 percent and attainment of target diastolic pressure improved by 6 percent.

  • The largest improvements were associated with organizational changes such as instituting multidisciplinary teams and computer-based record systems and using nurses to identify, manage, and follow-up with high-risk patients.
  • Specific interventions included patient reminder letters or calls, physician prompts and computer-based decision support, and patient education to promote chronic disease self-management.

Measure:

  • For blood pressure measurement, the denominator includes community-dwelling adults ages 18 and older. The numerator contains the subset of the denominator population who reported that their blood pressure was measured within the past two years and could recall whether their blood pressure reading was high or low (AHRQ 2006).
  • For treatment and control, the denominator includes community-dwelling adults ages 18 and older who had high blood pressure (average systolic pressure of at least 140 mmHg or average diastolic pressure of at least 90 mmHg), or who reported taking blood pressure medication in the past month. For treatment, the numerator contains the subset of the denominator population who were taking blood pressure medication. For control, the numerator contains the denominator population who had systolic blood pressure less than 140 mmHg and diastolic pressure less than 90 mmHg (based on an average of three measurements) and were taking blood pressure medication. Rates of blood pressure control were age-adjusted to the 2000 U.S. standard population (AHRQ 2006).

Limitations:

These data do not depict how many individuals with high blood pressure have been given lifestyle modification advice by their physician. The measure of blood pressure control does not include individuals with diagnosed hypertension who have controlled their blood pressure through lifestyle modification.

Source: