RESOLVING THE LEDGER
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Millions of Americans would benefit from blood pressure-lowering medications, research out today shows—yet plenty are going untreated.
An international team of researchers examined nationally representative survey data of Americans. Based on recently updated guidelines from the American Heart Association (AHA), roughly 22 million adults in the U.S. are eligible for drugs that lower blood pressure, but nearly half aren't taking them, the researchers found. Greater use of these drugs could prevent up to 200,000 deaths over the next decade, they further calculated.
"The current study has potential implications for both clinical practice and public health," the researchers wrote in their paper, published Tuesday in the Journal of the American Heart Association.
Last year, the AHA, in conjunction with the American College of Cardiology and others, updated its guidelines for managing high blood pressure, also called hypertension.
One important change was the recommendation that doctors now use a recently developed criterion to predict the 10-year and 30-year risk of cardiovascular disease in people between the ages of 30 and 79 without any known cardiovascular disease. This criterion, called PREVENT (Predicting Risk of cardiovascular disease EVENTs), is intended to account for cardiovascular factors that have historically been underappreciated, such as kidney and metabolic health.
Nearly Half of Americans Have Hypertension—and Most Aren't Doing Anything about It
The research team aimed to see how the new guidelines and the PREVENT criteria might shape the treatment of high blood pressure moving forward. To do so, they analyzed data from the National Health and Nutrition Examination Survey (NHANES), a nationally representative poll of Americans’ dieting and lifestyle habits regularly run by the Centers for Disease Control and Prevention. Specifically, they looked at NHANES data from 2009 to 2018.
Based on the NHANES data, about 81 million U.S. adults have been diagnosed with high blood pressure as of late. According to the updated guidelines, around 23 million were newly eligible for hypertension drugs. Of these, 13 million were already receiving some sort of medication, while 9.7 million (43%) weren't on any treatment.
Though hypertension alone doesn't guarantee that someone will experience a heart attack or other cardiovascular problem, it is a major risk factor, especially if it remains untreated. The researchers relied on the PREVENT criteria to estimate the benefits of expanded treatment.
Compared to untreated adults with hypertension, they found, people on these drugs had a 23% lower risk of dying from any cause and a 50% lower risk of dying from heart-related problems. What's more, if every eligible person went on blood pressure-lowering drugs, roughly 200,000 deaths from any cause and 162,000 cardiovascular deaths might be prevented in the U.S. over the following decade.
The researchers don't want to discount the importance of lifestyle changes for managing high blood pressure, such as exercise and less sodium in people's diets. But it's clear that many Americans who would benefit from these drugs aren't getting them, they say, and that this disparity is likely to lead to many preventable deaths.
“What stood out most was the size of the treatment gap—more than 40% of people who were clearly eligible under the new guideline were not receiving treatment, as well as the scale of the potential benefit,” said lead author Mustafa Al-Jarshawi, a scientist at the Cardiovascular Research Group at the Center for Prognosis Research at Keele University in the UK, in a statement released by the AHA.
So, yes, if you've ever been worried about your blood pressure, it might be time to schedule a visit with your primary care doctor and decide together how best to take care of your long-term heart and cardiovascular health.
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