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

This review assesses whether controlling hypertension in 50% of all patients is the best we can do. NHANES 2007-2008 data show that blood pressure was controlled to less than 140/less than 90 mmHg in 50% of all hypertensive patients, an increase from 27% in 1988-1994. The 50% control rate reflects the product of 72.5% of all patients treated and 69% of all treated patients controlled. However, there are opportunities for improvement, as 27.5% of all hypertensives, or 55% of uncontrolled patients, were untreated in 2007-2008. These individuals are disproportionately younger, men, and Hispanic. Moreover, 31% of all treated hypertensives, or 45% of uncontrolled patients, have blood pressure of at least 140/at least 90 mmHg. They are disproportionately older, women, and black. 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.