Patterns of Systolic Blood Pressure Control in the United States, 2016.

Abstract

Hypertension affects over 100 million individuals in the USA and is a major risk factor for cardiovascular disease (CVD).1 Treatment to reduce blood pressure (BP) reduces the risk of CVD, stroke, heart failure, chronic kidney disease, and all-cause mortality. Despite these benefits, the detection, treatment, and control of hypertension remain suboptimal. Treatment efforts need to be monitored because of their impact on public health. The standards for evaluating BP control have shifted over the past decade. JNC 7 targeted systolic blood pressure (SBP) < 140 mmHg for most and < 130 in higher risk patients.2 In contrast, JNC 8 relaxed treatment targets to < 150 in most older patients (age ≥ 60) and SBP < 140 for all others.3 Increasing evidence, particularly from SPRINT, suggests the feasibility and benefits of intensive BP control goals well below < 140/90.4 Recent AHA/ACC guideline targets 130/80 for a broad range of patients with elevated risk of CVD events.1 Racial/ethnic disparities in hypertension management persist. NHANES data shows the highest prevalence of hypertension among blacks as well as less adequate BP control among blacks and Hispanics. Lower socioeconomic status, independent of race/ethnicity, is correlated with higher prevalence of hypertension and CVD.1 We analyzed current national patterns of BP management using a variety of potential SBP targets to assess overall levels of BP control as well as disparities in treatment.