CardioExchange Archive

CardioExchange, an NEJM practice community for medical professionals dedicated to improving cardiac patient care, was active from 2009 to 2015. CardioExchange fostered discussion between clinicians from across the globe.

September 4th, 2012

CDC: Nearly 36 Million Americans Have Uncontrolled Hypertension

According to the Centers for Disease Control and Prevention, new data from the National Health and Nutrition Examination Survey (NHANES) show:

  • 30.4% of U.S. adults (an estimated 66.9 million people) have hypertension.
  • Of those with hypertension, 53.5% have uncontrolled hypertension (about 35.8 million people).
  • 39.4% with uncontrolled hypertension (about 14.1 million) are unaware that they have hypertension.
  • 89.4% with uncontrolled hypertension have a “usual source of health care and insurance, representing a missed opportunity for hypertension control.”

The CDC authors conclude: “The findings in this report can be used to target populations and refine interventions to improve hypertension control. Improved hypertension control will require an expanded effort from patients, health-care providers, and health-care systems.”

Categories: General, Prevention
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3 Responses to “CDC: Nearly 36 Million Americans Have Uncontrolled Hypertension”

  1. Richard Kones, MD PhD says:
    September 5, 2012 at 2:36 pm

    Information contained in this latest NHANES review, although not new, serves to raise public awareness and will hopefully promote greater adherence to therapies. Several NHANES reviews, in addition to 4 recent reports concerning the validity and usefulness of the American Heart Association’s “Simple 7” behaviors and factors, concur regarding the shortfall in blood pressure control. In addition to the AHA 2020 Goals, the Healthy People 2010 and Million Hearts initiatives also address this issue.

    There has been considerable progress in physician performance, with control rising from percentages in the 30s to nearly 50% presently, attributed in part to improvement in screening, prescribing, physician compliance with guidelines, and a greater spectrum of effective drugs. The elephants in the room, however, are the inexorable rise in BMI in the population, ongoing poor patient adherence, lack of improvement in sodium/potassium intake (0.015% of Americans satisfy both Na+ and K+ recommendations), and striking lack of physical activity (accelerometer data indicate about 4% of the population follows ACSM/CDC recommendations, but this is widely self-reported at a much higher figure).

    Some presentations of these data imply that, since about 90% of patients are under active care, physician performance is responsible for poor BP control. However, studies such as MI-FREEE and others clearly show lack of patient adherence is significant in CV management. Further, none of these commentaries add that 20%-30% of hypertensive cohorts manifest “resistant hypertension,” which requires “special handling” by clinicians.

    While there is undoubtedly a long road ahead toward optimal risk control, the contributions of the environment and socioeconomic milieu to the CV risk burden and upon patient adherence create barriers to BP control that should not be overlooked.

    Richard Kones MD

  2. Dan Hackam, MD PhD says:
    September 5, 2012 at 8:31 pm

    I believe the most common cause of inadequate hypertension control is excessive dietary carbohydrate intake (in the form of fruit, wheat, sugar, starchy vegetables, fruit juice, pop, rice, corn, oats, peas, ice cream, potato chips, processed foods, etc). It is really not surprising that between 1 in 4 and 1 in 3 people in the general population manifest metabolic syndrome qua carbohydrate intolerance. I have found very large drops (up to 30-40 mmHg) in systemic BP with restriction of dietary carbohydrate (together with improvements in HDL, triglycerides, CRP, fasting glucose, HbA1c, fasting insulin and waistline). Na/K and physical activity are really just red herrings – the standard American diet is toxic and leads to hypertension. Period. I have even been able to get many of my patients off BP, glucose and lipid medications after they have restricted carbohydrates from their diet.

  3. Richard Kones, MD PhD says:
    September 6, 2012 at 10:07 am

    Dr Dan Hackam’s comment brings up a close and complex relationship between carbohydrate intolerance and obesity, diabetes, metabolic syndrome, insulin resistance, Na/K and hypertension, likely mediated in part by increased renal Na absorption.

    See Horita et al (open access) http://www.hindawi.com/journals/ijht/2011/391762/

    Richard Kones MD