AIM: 75% of adults with heart disease risk also suffer from hypertension

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Nearly three-fourths of adults with cardiovascular comorbidities (CVCs) have hypertension, according to the Dec. 10/24 issue of the Archives of Internal Medicine.

Nathan Wong, PhD, of the University of California, Irvine, and colleagues, undertook the study because the prevalence and adequacy of its treatment and control in persons with CVCs are uncertain.

The researchers examined the prevalence, treatment and control of hypertension among U.S. adults with and without CVCs, we analyzed data from adults at least 18 years of age (4,646 patients/192.4 million) in the National Health and Nutrition Examination Survey 2003-2004, a nationally representative cross-sectional survey of the non-institutionalized civilian U.S. population. Prevalence, treatment, and control rates of hypertension in patients with CVCs was compared to those without, including coronary artery disease (CAD), congestive heart failure, stroke, chronic kidney disease (CKD), peripheral artery disease, and diabetes mellitus, as well as distance to blood pressure goal in those whose hypertension were not controlled.

The overall prevalence rate of hypertension was 31.4 percent (1,671 patients/60.5 million), ranging from 23.1 percent in those without CVCs to 51.8 percent to 81.8 percent in those with CVCs. Despite hypertension treatment rates for diabetes mellitus, stroke, heart failure and CAD that are higher (83.4 percent to 89.3 percent) than the rates of those without the conditions (66.5 percent). Control rates for treatment remained poor (23.2 percent to 49.3 percent). Isolated systolic HTN was the most common hypertensive subtype in those with CVCs (greater than or equal to 63.5 percent) with systolic blood pressure averaging at least 20 mm Hg from goal.

The researchers found that hypertension among people with cardiovascular diseases and related conditions. The following proportions suffered from hypertension: diabetes, 76.8 percent; CKD 81.8 percent; stroke, 69.5 percent; congestive heart failure, 71.4 percent; periphery artery disease, 73.7 percent; CAD, 73 percent; and at least two of the above-mentioned diseases, 76.9 percent. Poor control rates of systolic hypertension remain a principal problem that further compromises their already high cardiovascular disease risk.

Of the percentages listed above, at least 75 percent were being treated for high blood pressure. However, just one third of those being treated managed to reach their blood pressure goal levels of 140/90 mg (130/80 for those with diabetes or chronic kidney disease). The researchers noticed that only 34.9 percent of stroke patients, 48.8 percent of heart failure patients, 46.7 percent of peripheral arterial disease patients, and 50.3 percent of those with CAD managed to reach their blood pressure goals.

Of the diabetes and chronic diseases patients who had lower goals, just 35 percent and 23 percent respectively were controlled for their blood pressure. The patients who were uncontrolled had a systolic pressure 20 points higher than their targets.

The researchers concluded that “poor control rates of systolic hypertension remain a principal problem that further compromises the already high cardiovascular disease risk (in these individuals). Moreover, given recently released recommendations to reduce the blood pressure goal to less than 130/80 milligrams of mercury for persons with CAD and other high-risk conditions, our hypertension control rates would be even lower and a greater distance from the goal for these persons if the new criteria are applied.”