By: Thomas Pickering, MD, DPhil, FRCP, Director of Integrative and Behavioral Cardiology Program
of the Cardiovascular Institute at Mount Sinai School of Medicine, New York.

The goal for the treatment of hypertension is to keep the average blood pressure below 140/90 mmHg. A series of national surveys in the US have shown that the proportion of hypertensives whose pressure is controlled to this level increased from 10% to 29% between 1988 and 1991, but fell to 27% in 1993. A new survey, conducted in Olmsted County of Minnesota, an affluent neighborhood in the shadow of the Mayo Clinic, the Mecca of American health care, has found that the numbers are now even worse. A random sample of 636 people had their blood pressure taken both at home and in a clinic. Hypertension was defined as an average blood pressure above 140/90 mmHg or by a history of taking blood pressure medications. By these criteria, more than half of the people surveyed (53%) were classified as being hypertensive, and only 17% of the hypertensives who were being treated had pressures below 140/90 mmHg.

The percentages of hypertensives who were aware of their condition, and were on treatment, with or without being controlled, are shown in the table.

Percentages of hypertensives according to the awareness of their condition, treatment, and control.

Condition	Percent of total population
Unaware	38.7%
Aware, Untreated, Uncontrolled	10.4%
Aware, Untreated, Controlled	6.3%
Aware, Treated, Controlled	27.9%
Aware, Treated, Uncontrolled	16.6%

A similar survey had been done in 1986, and the average blood pressures had increased at the time of the present survey by 6.6 mmHg in systolic pressure, and 3.6 in diastolic.

Doctor’s comments

These findings are disturbing and show that the rate of adequate blood pressure control is getting worse, not better, despite the fact that we have many more blood pressure lowering medications than 10 years ago. The reasons are unexplained, but there seems to be a sense of complacency about high blood pressure in the US today, and as a nation we are getting fatter, which could also be contributing factor.

Where it was published

I Meissner and colleagues. Detection and control of high blood pressure in the community. Do we need a wake-up call? Hypertension 1999;34:466.