Is blood pressure control to less than 140/less than 90 mmHg in 50% of all hypertensive patients as good as we can do in the USA: or is this as good as it gets?

Abstract

Initiatives to raise hypertension treatment from 72.5% in 2007-2008 to 87.5% in the future are conceivable by targeting unaware and untreated patient groups and engaging them in ongoing healthcare. This could improve hypertension control by an absolute 10% of all patients. Reducing therapeutic inertia and increasing therapeutic efficiency could raise the proportion of patients on treatment who are controlled from 69 to 80% and could increase hypertension control by 8%. Combining these approaches could raise hypertension control to 70% of all hypertensive adults in the USA.

Family Physicians’ Quality Interventions and Performance Improvement for Hypertension through Maintenance of Certification

“…Patient questionnaire responses supported improvements reported in chart-derived quality measures in both hypertension-related counseling and changes in physician/clinic behaviors. Reports from other studies suggest that blood pressure for upwards of half of patients with hypertension is not adequately controlled (Egan & Laken, 2011). This contrasts starkly with our finding that 87.4% of patients in our study had adequate blood pressure control at baseline; however, our findings are within range for the baseline control reported in a recent trial to improve hypertension care (Petersen et al, 2013).…”

Treatment of Hypertension Among African Americans: The Jackson Heart Study

“…21 The complement of this proportion, i.e., proportion of persons with treated uncontrolled hypertension who were receiving fewer than 3 medications, can be considered a proxy for the rate of therapeutic inertia. 22 In the JHS, this estimate of therapeutic inertia was 70% and 64% at Exams I and II, compared to the national estimate of 72% for the NHANES survey conducted during 2005–2008. 22 Current guidelines emphasize that most hypertensives will require at least two medications to control their blood pressure; the JNC7 recommends that if BP is > 20/10 mm Hg over the target, therapy should employ two medications at initiation; 7 ISIHB guidelines tighten this recommendation to apply to all with BP > 15/10 mm Hg over target.…”

“…22 In the JHS, this estimate of therapeutic inertia was 70% and 64% at Exams I and II, compared to the national estimate of 72% for the NHANES survey conducted during 2005–2008. 22 Current guidelines emphasize that most hypertensives will require at least two medications to control their blood pressure; the JNC7 recommends that if BP is > 20/10 mm Hg over the target, therapy should employ two medications at initiation; 7 ISIHB guidelines tighten this recommendation to apply to all with BP > 15/10 mm Hg over target. 11 Of the JHS participants receiving monotherapy, 11% and 10% at Exams 1 and II, respectively, had BP > 20/10 mm Hg above their target BP, and perhaps should have been receiving more than one medication to treat their hypertension.…”

Trends in Blood Pressure and Hypertension Detection, Treatment, and Control 1980 to 2009

“…16 Some authorities have even speculated that the attainment of a goal blood pressure of 140/90 or less in 50% of hypertensives may be “the best we can do”. 17 …”

“…5 The 2020 goal for the American population is 61.2% of the population aware of hypertension and, treated and controlled (ATC). Despite the suggestion that moving the population to a figure above 50% ATC will be difficult, 17 these targets seem very achievable based on the Minnesota experience. It is already attained in studies in Canada and Northern Sweden.…”