Trends in Blood Pressure Control Among US Adults With Hypertension, 1999-2000 to 2017-2018

Muntner, Paul; Hardy, Shakia T; Fine, Lawrence J.; Jaeger, Byron C.; Wozniak, Gregory; Levitan, Emily B; Colantonio, Lisandro D.

doi:10.1001/jama.2020.14545

Cited by 649 publications

(644 citation statements)

References 40 publications

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“…Similarly, the current data in Mississippi hypertensives demonstrate significantly higher HTN prevalence in blacks as compared to whites (57 vs. 45%, respectively) with an average age of 50 and 57 years, respectively ( Table 1). Additionally, compared to white hypertensives, BP control rates in black hypertensives are significantly lower, ∼42-60% (2,13,21). Indeed, in the current study, black male BP control rates were statistically lower overall than in white males (36 vs. 41%, respectively, p = 0.003).…”

Section: Discussioncontrasting

confidence: 57%

“…Clinical studies investigating antihypertensive efficacy characterize the black population as a significant predictor of a poor blood pressure (BP) response (1,2), and there has not been a consistent improvement in the last 20 years (3). Black Americans of all ages have a greater frequency and severity of uncontrolled hypertension (HTN) and greater risks from high BP as compared to the white population (4)(5)(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

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Racial and Sex Differences in the Response to First-Line Antihypertensive Therapy

Clemmer

Pruett

Lirette

2020

Front. Cardiovasc. Med.

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Objective: As compared to whites, the black population develops hypertension (HTN) at an earlier age, has a greater frequency and severity of HTN, and has poorer control of blood pressure (BP). Traditional practices and treatment efforts have had minor impact on these disparities, with over a 2-fold higher death rate currently for blacks as compared to whites. The University of Mississippi Medical Center (UMC) is located in the southeastern US and the Stroke Belt, which has higher rates of HTN and related diseases as compared to the rest of the country.Methods: We retrospectively analyzed the UMC's Research Data Warehouse, containing >30 million electronic health records from >900,000 patients to determine the initial BP response following the first prescribed antihypertensive drug.Results: There were 5,973 white (45% overall HTN prevalence) and 10,731 black (57% overall HTN prevalence) patients who met criteria for the study. After controlling for age, BMI, and drug dosage, black males were overall less likely to have controlled BP (defined as < 140/90 mmHg) and were associated with smaller falls in BP as compared to whites and black females. Blockers of the renin-angiotensin system (RAS) failed to significantly improve odds of HTN control vs. the untreated group in black patients. However, our data suggests that these drugs do provide significant benefit in blacks when combined with THZ, as compared to untreated and as compared to THZ alone.Conclusion: These data support the use of a single-pill formulation with ARB or ACE inhibitor with a thiazide in blacks for initial first-line HTN therapy and suggests that HTN treatment strategies should consider both race and gender. Our study gives a unique insight into initial antihypertensive responses in actual clinical practice and could have an impact in BP control efficiency in a state with prevalent socioeconomic and racial disparities.

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Section: Discussioncontrasting

confidence: 57%

Section: Introductionmentioning

confidence: 99%

Racial and Sex Differences in the Response to First-Line Antihypertensive Therapy

Clemmer

Pruett

Lirette

2020

Front. Cardiovasc. Med.

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“…Indeed, previous research found patients with a regular source of care were more likely to know that they had hypertension compare to patients without a usual source of care. 14 Our analyses focused on diagnosis incidence rates as the study main outcomes; other outcomes such as time to obtaining diagnosis may be more sensitive to ACA-related changes in our population of interest. Finally, while we did not see large changes in the hypertension and diabetes diagnosis rates among this CHC population, patients without stable health insurance may not be able to seek regular care, 29 afford medications, or adjust medications as needed to control symptoms, 30 therefore, the presence of absence of stable health insurance may have a larger impact on these outcomes than on incidence of disease.…”

Section: Discussionmentioning

confidence: 99%

“… 13 For example, nearly 85% of US adults with hypertension were aware of the diagnosis in 2013–2014, whereas awareness declined to 77% in 2017–2018. 14 Nearly 30% of adults without health insurance were unaware of their hypertension in comparison to more than 14% of those with health insurance. 12 In addition, the HealthyPeople 2020 target for those with diabetes to receive a correct diagnosis (79.8%) has been met or is closely approaching the target in those with high educational attainment, while trailing for those with less than a high school degree (70.9%).…”

Section: Introductionmentioning

confidence: 99%

New hypertension and diabetes diagnoses following the Affordable Care Act Medicaid expansion

et al. 2020

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ObjectiveTo assess the Affordable Care Act (ACA) Medicaid expansion’s impact on new hypertension and diabetes diagnoses in community health centres (CHCs).DesignRates of new hypertension and diabetes diagnoses were computed using generalised estimating equation Poisson models and we tested the difference-in-difference (DID) pre-ACA versus post-ACA in states that expanded Medicaid compared with those that did not.SettingWe used electronic health record data (pre-ACA: 1 January 2012–31 December 2013—post-ACA: 1 January 2014–31 December 2016) from the Accelerating Data Value Across a National Community Health Center Network clinical data network. We included clinics with ≥50 patients contributing to person-time-at risk in each study year.ParticipantsPatients aged 19–64 with ≥1 ambulatory visit in the study period were included. We then excluded patients who were pregnant during the study period (N=127 530). For the hypertension outcome, we excluded individuals with a diagnosis of hypertension prior to the start of the study period, those who had a hypertension diagnosis on their first visit to a clinic or their first visit after 3 years without a visit, and those who had a diagnosis more than 3 years after their last visit (pre-ACA non-expansion N=130 973; expansion N=193 198; post-ACA non-expansion N=186 341; expansion N=251 015). For the diabetes analysis, we excluded patients with a diabetes diagnosis prior to study start, on their first visit or first visit after inactive patient status, and diagnosis while not an active patient (pre-ACA non-expansion N=145 435; expansion N=198 558; post-ACA non-expansion N=215 039; expansion N=264 644).ResultsIn non-expansion states, adjusted hypertension diagnosis rates saw a relative decrease of 6%, while in expansion states, the adjusted rates saw a relative increase of 7% (DID 1.14, 95% CI 1.11 to 1.18). For diabetes diagnosis, adjusted rates in non-expansion states experienced a significant relative increase of 28% and in expansion states the relative increase was 25%; yet these differences were not significant pre-ACA to post-ACA comparing expansion and non-expansion states (DID 0.98, 95% CI 0.91 to 1.05).ConclusionThere was a differential impact of Medicaid expansion for hypertension and diabetes diagnoses. Moderate increases were found in diabetes diagnosis rates among all patients served by CHCs post-ACA (both in expansion and non-expansion states). These increases suggest that ACA-related opportunities to gain health insurance (such as marketplaces and the Medicaid expansion) may have facilitated access to diagnostic tests for this population. The study found a small change in hypertension diagnosis rates from pre-ACA to post-ACA (a decrease in non-expansion and an increase in expansion states). Despite the significant difference between expansion and non-expansion states, the small change from pre-ACA to post-ACA suggests that the diagnosis of hypertension is likely documented for patients, regardless of health insurance availability. Future studies are needed to understand the impact of the ACA on hypertension and diabetes treatment and control.

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“…A recent article showed that hypertension control is getting worse, not better. 18 The rates of diabetes, along with obesity, are rising rapidly, starting almost 25 years ago. Deaths from atrial fibrillation are also increasing.…”

Section: Setting the Stagementioning

confidence: 99%

Inflection Point

Krumholz

2020

Circ: Cardiovascular Quality and Outcomes

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Trends in Blood Pressure Control Among US Adults With Hypertension, 1999-2000 to 2017-2018

Abstract: IMPORTANCE Controlling blood pressure (BP) reduces the risk for cardiovascular disease.

Cited by 649 publications

References 40 publications

Racial and Sex Differences in the Response to First-Line Antihypertensive Therapy

Racial and Sex Differences in the Response to First-Line Antihypertensive Therapy

New hypertension and diabetes diagnoses following the Affordable Care Act Medicaid expansion

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