Control Rates of Hypertension in North America

Abstract

Despite the extensive evidence from epidemiological studies showing that hypertension is a major risk factor for premature cardiovascular morbidity and mortality and from randomized clinical trials showing that this risk can be markedly reduced by antihypertensive drug therapy, hypertension is generally considered to be poorly managed. Surveys performed in the 1990s reported low rates for awareness, treatment, and control of hypertension. Since better once-daily antihypertensive drugs with less adverse effects have become available and both healthcare providers and the general public appear to place more emphasis on prevention of cardiovascular disease, one may expect these advances to translate not only into more awareness of the presence of hypertension but also into better treatment and control rates. Indeed, successive reports from National Health and Nutrition Examination Survey (NHANES) reported progressive improvement in awareness, treatment, and control rates, up to 80.7%, 72.5%, and 50.1%, respectively, for the 2007–2008 survey.1 Two recent Canadian surveys reported even more substantial improvements in treatment and control rates in the general hypertension population. First, a survey in Ontario, the largest province of Canada, with an adult population of ≈8 million, reported 86.3% awareness, 80.5% treatment, and 65.7% control rates.2 Then, a Canada-wide survey provided similar high rates: 83.4,% 79.9,% and 65.9% for awareness, treatment, and control rates for adults with hypertension, 20 to 79 years of age.3 These rates are only 10% to 25% below the “optimal” rates that one may expect in a cross-sectional survey. The results from NHANES and …