Proceedings From a National Heart, Lung, and Blood Institute and the Centers for Disease Control and Prevention Workshop to Control Hypertension

Abstract

Hypertension treatment and control prevent more cardiovascular events than management of other modifiable risk factors. Although the age-adjusted proportion of US adults with controlled blood pressure (BP) defined as <140/90 mm Hg, improved from 31.8% in 1999-2000 to 48.5% in 2007-2008, it remained stable through 2013-2014 and declined to 43.7% in 2017-2018. To address the rapid decline in hypertension control, the National Heart, Lung, and Blood Institute and the Division for Heart Disease and Stroke Prevention of the Centers for Disease Control and Prevention convened a virtual workshop with multidisciplinary national experts. Also, the group sought to identify opportunities to reverse the adverse trend and further improve hypertension control. The workshop immediately preceded the Surgeon General's Call to Action to Control Hypertension, which recognized a stagnation in progress with hypertension control. The presentations and discussions included potential reasons for the decline and challenges in hypertension control, possible "big ideas," and multisector approaches that could reverse the current trend while addressing knowledge gaps and research priorities. The broad set of "big ideas" was comprised of various activities that may improve hypertension control, including: interventions to engage patients, promotion of self-measured BP monitoring with clinical support, supporting team-based care, implementing telehealth, enhancing community-clinical linkages, advancing precision population health, developing tailored public health messaging, simplifying hypertension treatment, using process and outcomes quality metrics to foster accountability and efficiency, improving access to high-quality health care, addressing social determinants of health, supporting cardiovascular public health and research, and lowering financial barriers to hypertension control.

Keywords: blood pressure; cardiovascular disease; hypertension; prevention; screening.

Graphical Abstract

Figure 1.

Trends in blood pressure control among US adults with hypertension, 1999–2000 to 2017–2018. Age-adjusted estimated proportion of adults with hypertension and controlled blood pressure. NHANES indicates National Health and Nutrition Examination Survey. Hypertension was defined as systolic blood pressure (SBP) level of 140 mm Hg or higher, diastolic blood pressure (DBP) level of 90 mm Hg or higher, and antihypertensive medication use. Controlled blood pressure was defined as SBP level lower than 140 mm Hg and DBP level lower than 90 mm Hg in panels (a) and (b) and SBP level lower than 130 mm Hg and DBP level lower than 80 mm Hg in panels (c) and (d). Treatment was defined by self-reported antihypertensive medication use. Among all adults with hypertension, blood pressure control from 1999–2000 through 2007–2008 yielded P < 0.001 for trend; from 2007–2008 through 2013–2014, P = 0.14 for trend; and from 2013–2014 through 2017–2018, P = 0.003 for trend. Among adults taking antihypertensive medication, blood pressure control from 1999–2000 through 2007–2008 yielded P < 0.001 for trend; from 2007–2008 through 2013–2014, P = 0.12 for trend; and from 2013–2014 through 2017–2018, P = 0.005 for trend. Age adjustment was performed using direct standardization with the standard being all adults across the entire period (1999–2018); the age categories used for standardization were 18–44 years (15.5%), 45–64 years (45.4%), 65–74 years (21.5%), and 75 years or older (17.7%). The line segments were generated using Joinpoint (National Cancer Institute). * Among all adults with hypertension. ^† Among adults who self-reported taking antihypertensive medication.

Figure 2.

Hypertension control cascade and change in selected factors, NHANES 2009–2018. Abbreviation: NHANES, National Health and Nutrition Examination Survey.