Hypertension worsening in all states for women; stagnates for men

Feb 12 2008

Uncontrolled hypertension rates in men and women vary across the country, but all states - especially in the south and including the nation's capital - should boost blood pressure control efforts, researchers report in Circulation: Journal of the American Heart Association.

Uncontrolled hypertension in this study was defined as above 140 millimeters of mercury. The measurements were taken in a mobile examination clinic (MEC) and averaged. The first measurement was excluded. Those unable to visit the mobile clinic were offered a limited exam at home.

“Not much has been known about how individual states measure up when it comes to hypertension prevalence because only self-reported hypertension status has been measured at the state level,” said Majid Ezzati, Ph.D., lead author of the study and associate professor of International Health at the Harvard School of Public Health in Boston, Mass.

“In this study, we found a way to take the existing information and relatively accurately determine each state's true prevalence of uncontrolled hypertension among men and women, as well as how many lives might be saved if we do a better job of controlling blood pressure in individual states.”

Ezzati and colleagues first examined blood pressure trends nationally using the National Health and Nutrition Examination Survey and the Behavioral Risk Factor Surveillance System. They found that prevalence rates of uncontrolled hypertension had been declining for decades up to the 1990s. However, throughout the 1990s high uncontrolled hypertension rates among U.S. men began to stagnate or decline at a slower rate.

The trend among women was more alarming, with hypertension rates in the 1990s reversing and beginning to increase, researchers said.

Between the early 1990s and early 2000s, the prevalence of uncontrolled hypertension in adult women increased from 17 percent to more than 22 percent. At the same time, the rate of hypertension in men decreased from 19 percent to 17 percent. Even if blood pressure among American women had stayed at its levels of a decade ago, American women of different ages would have between 2 percent and 4 percent less heart disease and stroke, Ezzati said.

When researchers determined the prevalence in individual states they found that some are doing far worse than others. The worst uncontrolled hypertension rates in the United States are in the District of Columbia and in the South (Mississippi, Alabama, Louisiana, Texas, Georgia and South Carolina).

“The prevalence of uncontrolled hypertension among men in these states hovers between 18 percent and 21 percent,” Ezzati said. “And about a quarter of adult women in these states (24 percent to 26 percent) have uncontrolled hypertension.”

The states with lower hypertension prevalence rates are Vermont, Minnesota, Connecticut, New Hampshire, Iowa and Colorado. They have rates between 15 percent and 16 percent for men and about 21 percent for women.

“We also found that in every state in the United States women have higher uncontrolled hypertension prevalence rates than men do. The difference between men and women is as low as 4 percent and as high as 7 percent,” he said.

In the 1990s, according to the study, uncontrolled hypertension for women increased the most in Idaho and Oregon (up 6 percentage points) and the least in Washington, D.C., and Mississippi (down 3 percentage points). For men, the worst-performing (smallest decline) states were New Mexico and Louisiana and the best-performing states were Vermont and Indiana.

“The variation in increases should be interpreted with caution,” Ezzati said. “We can't tell from our study why this is happening. It could be that the states have done a better job in their public health efforts to reduce hypertension or it could be that rates are already so high that they didn't have much higher to go.”

Researchers determined that between 2001 and 2003, deaths attributed to the higher than optimal systolic blood pressure control among females ranged from 200 to 220 per 100,000 in Minnesota and Massachusetts to 360 to 370 in Washington, D.C., and Mississippi. For males, deaths from high blood pressure were 210 per 100,000 in Colorado and Utah to 370 in Mississippi and 410 in Washington, D.C.

“It is alarming that U.S. states are experiencing worsening rates for a risk factor that is so easily controlled by lifestyle, diet and medication,” Ezzati said. “We need to look nationally, but also especially focus on those states with the highest hypertension prevalence and emphasize interventions to do better than last decade's trends.”

“High blood pressure is the most commonly occurring preventable risk factor for heart disease and stroke,” said Dan Jones, M.D., President of the American Heart Association. “Easily applied methods for prevention and treatment are available. It is amazing that blood pressure control rates are not improving in our country. Public health officials, policy makers, health professionals, and the American public need to respond. With more exercise, better diets, and appropriate use of antihypertensive medications, this disturbing trend in low control rates can be resolved.”