Hypertension Control Varies by Geography, Demographics

Nicola M. Parry, DVM

September 19, 2017

Two thirds of US patients have their hypertension under control, and wide geographic and demographic variations in hypertension control exist across the United States, according to a report published online September 19 by the Centers for Disease Control and Prevention (CDC) in National Health Statistics Reports.

"Poor hypertension control at hypertensive visits was more widespread in states considered to be part of the 'stroke belt', which is an 11-state region in the southeast United States characterized by stroke rate death rates that are 10% higher than the US average," write Jill J. Ashman, PhD, and colleagues, from the CDC's National Center for Health Statistics, Hyattsville, Maryland.

"The states included in the stroke belt are: Alabama, Arkansas, Georgia, Indiana, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, and Virginia."

Almost one third of US adults have hypertension, putting them at risk for cardiovascular disease and stroke, the authors note in the report. Improved awareness, treatment, and control of hypertension are key to reducing morbidity, mortality, and costs associated with the condition, they stress.

In a survey from 2011-2014, for an estimated 53% of adults aged 18 years and older with hypertension, the patients' high blood pressure was under control.

The new report is based on a 2013-2014 survey of visits by nonpregnant adults with hypertension to nonfederal, office-based primary care physicians (PCP). The survey included oversampling of 18 states, and the researchers analyzed data from 10,288 hypertensive visits, representing a weighted total of 121.9 million annualized visits. They defined hypertension control as a blood pressure measurement of less than 140/90 mm Hg.

According to the authors, 46.9% of all PCP visits by nonpregnant adults from 2013 to 2014 were made by hypertensive patients. Hypertension in these patients was found to be under control at 66.0% of hypertensive visits, and a hypertensive medication was mentioned at 72.0% of them.

Geography and Demographics

The researchers also found substantial geographic and demographic variations in hypertension control.

The percentage of hypertensive visits varied among different states (from 53.7% in Tennessee to 73.2% in Florida), as well as among different regions (from 60.1% in the East South Central region to 71.1% in New England).

The percentage of hypertensive visits that included a mention of hypertensive medication ranged from 57.1% in Georgia to 85.0% in Washington. And the percentages of hypertensive visits that both indicated hypertension control and mentioned hypertensive medication were lower than the national estimate (46.9%) in Tennessee (32.6%) and Georgia (32.8%), and were higher in Florida (56.1%), Washington (57.2%), and Wisconsin (58.1%).

"In Tennessee, 37.6% of hypertensive visits indicated uncontrolled hypertension, despite including a hypertensive medication, which was about 50% higher than the national estimate of 25.2%," the authors add.

"In addition, in Georgia, of the hypertensive visits that did not include a hypertensive medication, 37.7% indicated uncontrolled hypertension, which represented 16.2% of all hypertensive visits in the state and was almost double that of the national estimate of 8.8%."

The survey also showed that hypertension was under control less frequently at hypertensive visits by non-Hispanic black patients (57.4%) than at those by all other racial or ethnic groups (non-Hispanic white, 66.9%; Hispanics, 69.2%; non-Hispanic other patients, 67.3%).

However, the percentage of hypertensive visits that included a mention of hypertensive medication did not differ across these racial and ethnic groups, the authors note.

These geographic and demographic differences "may help inform local policies and initiatives to better improve hypertension control and use of hypertensive medications at the population level," Dr Ashman and colleagues conclude.

The authors have reported no relevant financial relationships.

Nat Health Stat Report. Published online September 19, 2017. Full text

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