Abstract
Background: Cardiovascular disease (CVD) is the number one killer in US women, and hypertension the most common modifiable risk factor. Though women have had better control of hypertension than men, control rates have declined over the past decade. We quantify US population estimates of missed opportunities for hypertension control in premenopausal women with access to regular healthcare. Methods: We used National Health and Nutrition Examination Survey (2011-2018) to identify US women aged 35-54 years with no prior CVD. Within this sample we identified the population prevalence of respondents with hypertension (SBP ≥ 140mmHg or DBP ≥ 90mmHg), a usual healthcare provider, attending at least two visits per year, awareness (ever been told you have hypertension), treatment (prescribed and taking hypertension medication) and control (SBP < 140mmHg) of blood pressure. We derived hypertension control cascades for this population comparing 2011-2014 and 2015-2018. Results: The prevalence of hypertension in women age 35-54 years with no prior CVD was 6.4M in 2011-2014 and rose to 8.5M in 2015-2018. The prevalence at each stage and the missed opportunities to intervene are presented in the hypertension control cascade (Figure 1). In 2015-2018 only two thirds of this population had access to regular healthcare. Among the women with hypertension in regular care, the greatest missed opportunity occurred in those who are unaware of their hypertension (25%), followed by those untreated (11%) and uncontrolled (6%). Conclusion: The number of premenopausal women with hypertension in the US increased by 25% from the start to the finish of the prior decade. Although most of these 2.1 million women are cared for by healthcare professionals, considerable gaps exist in awareness, treatment, and control of their hypertension, gaps that have not improved substantially over the decade. Improvements in hypertension prevention, access to care, and delivery of guideline-concordant care for premenopausal women should be a priority.
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