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An alarming new study finds that a growing percentage of Americans have uncontrolled high blood pressure, further evidence that the nation is losing ground in the fight against heart disease. Hypertension, often called the “silent killer,” is also one of the top risks for serious illness from COVID-19.
An analysis of data from more than 18,000 patients with high blood pressure found that the proportion of uncontrolled hypertension had increased by 10 percent in 2017-18, compared with 2013 to 2014, according to the report published Wednesday in JAMA.
“These were sobering conclusions,” said the study’s lead author, epidemiologist Paul Muntner, dean of research at the University of Alabama at Birmingham. “I was surprised. But at the same time, we saw indications that align with this data.”
An earlier study found that many patients were not prescribed blood pressure-lowering drugs according to guidelines. Many of those with uncontrolled hypertension were being treated with a single drug rather than a combination of drugs, which may be more effective in lowering blood pressure, Muntner said.
To take a closer look at how well hypertension was being addressed in the United States, Muntner and his colleagues turned to the U.S. National Health and Nutrition Examination Survey (NHANES), which has been collecting health data every two years during the last two decades.
The researchers considered that hypertension is under control if:
- the systolic measurement (the top number) was less than 140 mm Hg.
- the diastolic measurement (the bottom number) was less than 90 mm Hg.
Those numbers are lower than what’s called for in the most recent guidelines, which say people should aim for 130 out of 80.
Of the 18,262 adults diagnosed with hypertension, the proportion with blood pressure under control increased from 31.8 percent in 1999-2000 to 48.5 percent in 2007-08 and remained stable for several years. In 2013-14, the proportion with controlled hypertension rose to 53.8 percent.
Our health in America is getting worse.
Then, the proportion of Americans with blood pressure under control dropped dramatically to just 43.7 percent in 2017-18. When the researchers re-analyzed their data using the new 130/80 mm Hg guidelines, they found that only 19 percent of Americans with hypertension had their blood pressure under control.
One of the most important factors related to blood pressure control was whether a person had seen a healthcare provider in the past year – those who had were five times more likely to have their blood pressure controlled compared to those who had not.
More than 100 million Americans have high blood pressure, according to the American Heart Association. Uncontrolled hypertension is the most important risk factor for cardiovascular problems such as heart attacks and strokes, experts said. It’s even more dangerous because when a patient has uncontrolled high blood pressure, COVID-19 is more likely to be fatal or lead to serious complications.
Since he was diagnosed with hypertension 10 years ago, Jonathan Taylor of New York City had maintained his blood pressure with medication and exercise. But the pandemic stress caused some fluctuations. Taylor, a 60-year-old professional tennis player, did not realize his condition was putting him at risk when he first developed COVID-19 in March.
“I’m generally someone who’s healthy,” Taylor said. “I look younger than my age to other people because I’ve always been in shape.”
At first, his blood pressure rose and fell and he felt weak and dizzy. Later, she developed chest pain, body aches, headaches, and a very low fever. After several days, he realized he was in trouble and called an ambulance. He was finally hospitalized for about 11 days and on oxygen.
“Wow, did this thing sneak up on me?” Taylor said. “That’s really scary because, overall, my health was pretty good. And then getting sick so quickly.”
Taylor is now home, back on her blood pressure medication and more health conscious than ever.
“It’s been a long recovery, but I’m doing quite well,” he said.
The Centers for Disease Control and Prevention estimate that people with hypertension are three times more likely to be hospitalized if they are infected with the coronavirus, compared to those without high blood pressure. And a study published in April in JAMA found that hypertension was one of the greatest predictors of severe illness and death from COVID-19, along with diabetes and obesity.
“We know that with COVID-19, cardiovascular risk factors increase the risk of complications,” said Dr. Luke Laffin, a cardiologist at the Cleveland Clinic. “So controlling hypertension is very important.”
People need to have their blood pressure checked at least once a year, and with many patients avoiding hospitals and doctors’ offices due to COVID-19 fears, those numbers could get worse.
“There has been a huge push, especially in the last three years, for people to monitor their own blood pressure at home,” Laffin said. “It is not good enough, particularly with people with hypertension, to simply control their blood pressure in the [doctor’s] office.”
The new findings are in line with other recent studies showing the United States is losing ground to heart disease, said Dr. Matthew Muldoon, a professor of medicine at the University of Pittsburgh School of Medicine and director of the UPMC Center for Hypertension.
“This new data is consistent with the reversal of our advances in the fight against cardiovascular disease,” Muldoon said. “Heart disease, cardiovascular events and mortality stopped going down and started going up. So we are losing ground. “
Dr. Erin Michos, a cardiologist at Johns Hopkins School of Medicine, said the new data parallels an increase in obesity and diabetes in the US.
Obesity, high blood pressure and diabetes are associated with a sedentary lifestyle and poor dietary intake, Michos said. “Our health in America is getting worse,” he said.
